Positional deformity of the subclavian artery as a possible cause of subclavian steal syndrome

Kirsanov R.I.^1,2, Kulikov V.P.¹, Belitsky S.N.³, Zhestovskaya S.I.⁴

1) Department of Functional Diagnosis, Regional Clinical Hospital,
2) Chair of Pathological Physiology, Altai State Medical University under the RF Ministry of Public Health,
3) Department of Radiological and Functional Diagnosis, Altai Regional Hospital for War Veterans, Barnaul,
4) Chair of Radiodiagnosis, Institute of Postgraduate Education, Krasnoyarsk State Medical University named after Professor V.F. Voino-Yasenetsky under the RF Ministry of Public Health, Krasnoyarsk, Russia

Using the method of duplex scanning, we examined a total of 123 patients presenting with a deformity of the subclavian artery (SCA). We assessed the Doppler spectrum of blood flow in the zone of the SCA deformity, as well as in V2 and V4 segments of the ipsilateral vertebral artery (VA) at rest and in breath holding on inspiration. Deformity of the SCA was observed on the right in 91% of cases, on the left in 5%, and on both sides in 4%. Haemodynamic disorders in the ipsilateral VA as a change of the shape of the Doppler spectrum according to the type of steal syndrome were noted in 10.8% of cases, with a more pronounced impairment of blood flow at the intracranial level – in 78.6% of cases. It was determined that a deformity of the SCA was characterised by a decrease in angulation (up to complete straightening) and a reduction of the peak systolic velocity on deep inspiration, thus reflecting its positional nature. Patients with initial impairment of the Doppler spectrum in the VA demonstrated normalization of the spectrum on an intake of breath. Hence, the index of the peak systolic velocity of blood flow in the zone of the SCA deformity in combination with assessment of the Doppler spectrum in the ipsilateral VA on inhalation may be used for determining the haemodynamic significance of a deformity of the SCA.

KEY WORDS: deformity, subclavian artery, vertebral artery, duplex scanning, Doppler spectrum, steal syndrome.

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