鎖骨下動脈スチール

関: subclavian artery stenosis、subclavian steal syndrome

WordNet

take without the owners consent; "Someone stole my wallet on the train"; "This author stole entire paragraphs from my dissertation"
a stolen base; an instance in which a base runner advances safely during the delivery of a pitch (without the help of a hit or walk or passed ball or wild pitch)
move stealthily; "The ship slipped away in the darkness" (同)slip
steal a base
situated beneath the clavicle

PrepTutorEJDIC

(…から)〈物〉‘を'『盗む』《+『名』〈物〉+『from』+『名』》 / (…から)…‘を'こっそり取る,うまく手に入れる+『名』+『from』+『名』》 / (野球で)〈塁〉‘を'盗む,‘に'盗塁する / 盗みをする / 《方向・場所を表す副詞[句]を伴って》こっそり動く / 〈U〉《米話》こっそりと盗むこと;〈C〉盗品 / 〈C〉《単数形で》《米話》格安品,掘り出し物 / 〈C〉(野球で)盗塁
〈U〉盗むこと;(野球で)盗塁,スチール / 〈C〉《複数形で》盗品

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/10/21 14:35:24」(JST)

wiki en

[Wiki en表示]

The promixal part of left subclavian is blocked on left side so no flow in vertebral and to left arm.blood from right vertebral enters left vertebral and flows back to supply left arm

In medicine, subclavian steal syndrome (SSS), also called subclavian steal phenomenon or subclavian steal steno-occlusive disease, is a constellation of signs and symptoms that arise from retrograde (reversed) flow of blood in the vertebral artery or the internal thoracic artery, due to a proximal stenosis (narrowing) and/or occlusion of the subclavian artery. The arm may be supplied by blood flowing in a retrograde direction down the vertebral artery at the expense of the vertebrobasilar circulation. This is called the subclavian steal.

Pathophysiology[edit]

Classically, SSS is a consequence of a redundancy in the circulation of the brain^[1]^[2] and the flow of blood.

SSS results when the short low resistance path (along the subclavian artery) becomes a high resistance path (due to narrowing) and blood flows around the narrowing via the arteries that supply the brain (left and right vertebral artery, left and right internal carotid artery). The blood flow from the brain to the upper limb in SSS is considered to be stolen as it is blood flow the brain must do without. This is because of collateral vessels.

As in vertebral-subclavian steal, coronary-subclavian steal may occur in patients who have received a coronary artery bypass graft using the internal thoracic artery (ITA), also known as internal mammary artery.^[3] As a result of this procedure, the distal end of the ITA is diverted to one of the coronary arteries (typically the LAD), facilitating blood supply to the heart. In the setting of increased resistance in the proximal subclavian artery, blood may flow backward away from the heart along the ITA causing myocardial ischemia. Vertebral-subclavian and coronary-subclavian steal can occur concurrently in patients with an ITA CABG.^[4]

Hemodynamics[edit]

Blood, like electrical current, flows along the path of least resistance. Resistance is affected by the length and width of a vessel (i.e. a long narrow vessel has the greatest resistance and a short fat one the least), but crucially in the human body width is generally more limiting than length because of Poiseuille's Law. Thus, if blood is presented with two paths, a short one that is narrow (with a high overall resistance) and a long one that is wide (with a low overall resistance), it will take the long and wide path (the one with the lower resistance).

Vascular anatomy[edit]

The blood vessels supplying the brain arise from the vertebral arteries and internal carotid arteries and are connected to one another by communicating vessels that form a circle (known as the Circle of Willis).

Path of the blood (normal versus SSS)[edit]

Normally, blood flows from the aorta into the subclavian artery, and then some of that blood leaves via the vertebral artery to supply the brain.

In SSS a reduced quantity of blood flows through the proximal subclavian artery. As a result, blood travels up one of the other blood vessels to the brain (the other vertebral or the carotids), reaches the basilar artery or goes around the cerebral arterial circle and descends via the (ipsilateral) vertebral artery to the subclavian (with the proximal blockage) and feeds blood to the distal subclavian artery (which supplies the upper limb and shoulder).

Etiology[edit]

Atherosclerosis
Cervical rib
Takayasu's arteritis

Signs and symptoms[edit]

Presyncope (sensation that one is about to faint)
Syncope (fainting)
Neurologic deficits
Blood pressure differential between the arms
severe memory problems
hands showing circulation problems (hands can have blotchy patches of red and white) (associated with other stigma to vascular disease (e.g. vascular insufficiency ulcers of the foot).

Differential diagnosis[edit]

Stroke

Diagnostic tests[edit]

Doppler ultrasound
CT angiography
Angiogram

Treatment[edit]

Stent and balloon angioplasty
Endarterectomy

References[edit]

^ Klingelhöfer J, Conrad B, Benecke R, Frank B (1988). "Transcranial Doppler ultrasonography of carotid-basilar collateral circulation in subclavian steal.". Stroke 19 (8): 1036–42. doi:10.1161/01.STR.19.8.1036. PMID 3041649.
^ Lord R, Adar R, Stein R (1969). "Contribution of the circle of Willis to the subclavian steal syndrome". Circulation 40 (6): 871–8. doi:10.1161/01.CIR.40.6.871. PMID 5377222.
^ Takach T, Reul G, Cooley D, Duncan J, Livesay J, Ott D, Gregoric I (2006). "Myocardial thievery: the coronary-subclavian steal syndrome". Ann Thorac Surg 81 (1): 386–92. doi:10.1016/j.athoracsur.2005.05.071. PMID 16368420.
^ Lee S, Jeong M, Rhew J, Ahn Y, Na K, Song H, Bom H, Cho J, Ahn B, Park J, Kim S, Kang J (2003). "Simultaneous coronary - subclavian and vertebral - subclavian steal syndrome". Circ J 67 (5): 464–6. doi:10.1253/circj.67.464. PMID 12736489.

External links[edit]

Subclavian Steal Syndrome - emedicine.com

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 鎖骨下動脈盗血症候群 subclavian steal syndrome
2. Overview of surgical and endovascular techniques for upper extremity revascularization
3. 上肢末梢動脈疾患の概要 overview of upper extremity peripheral artery disease
4. 高安動脈炎の臨床的特徴および診断 clinical features and diagnosis of takayasu arteritis
5. 後方循環系の脳血管症候群 posterior circulation cerebrovascular syndromes

English Journal

Teaching Video NeuroImages: Asymptomatic subclavian-carotid double steal phenomenon due to innominate artery stenosis.

Muñoz R, Pulido L, Gállego J.SourceCorrespondence & reprint requests to Dr. Muñoz: robertoprovisional@hotmail.com.
Neurology.Neurology.2012 May 15;78(20):e125.
PMID 22585438

[Subclavian artery stenting using gadolinium contrast medium in a case with iodine allergy].

Miyamoto M, Asano T, Osanai T, Endo S, Nakayama N, Kuroda S, Houkin K.SourceDepartment of Neurosurgery, Hokkaido University Graduate School of Medicine.
No shinkei geka. Neurological surgery.No Shinkei Geka.2012 May;40(5):415-20.
The authors reported a subclavian artery stenting (SAS) using gadolinium contrast medium. The patient was a 65-year-old female who presented dizziness and right upper extremity pain with movement. Digital subtraction angiography revealed right subclavian artery occlusion with subclavian steal phenom
PMID 22538283

Japanese Journal

術中経食道心エコーで重度の鎖骨下動脈狭窄を診断した冠動脈バイパス術の1症例

山本匠,蒲生正裕,高森未奈
日本臨床麻酔学会誌 34(4), 500-504, 2014
… 6.8％に存在するとされ，その場合左内胸動脈グラフトの使用はcoronary-subclavian steal syndromeによる冠動脈虚血を起こす可能性があるため使用を避けるべきである．本症例では，麻酔導入後の経食道心エコーによる重度鎖骨下動脈狭窄の診断により，使用グラフトを変更し術後coronary-subclavian steal syndrome発生のリスクを回避できた．経食道心エコーは，鎖骨下動脈狭 …
NAID 130004687476

An Aberrant Subclavian Artery Exhibiting the Partial Steal Phenomenon in a Patient with VACTERL Association

, , ,
Internal Medicine 53(16), 1859-1861, 2014
… A neurosonological examination revealed a partial subclavian steal phenomenon. … CT angiography of the neck vessels and aortic arch confirmed an anomalous right subclavian artery -known as the lusorian artery. …
NAID 130004678415

ステント留置術と透析用バスキュラーアクセス縫縮術によって改善した鎖骨下動脈盗血症候群の1 例

小山淳一,花岡吉亀,佐藤篤,神應裕,宮下裕介
脳卒中 36(1), 47-50, 2014
要旨：症例は71 歳，女性，右片麻痺，構音障害を呈し搬送された．左前腕に透析用バスキュラーアクセスが作成されている．起床時の眼前暗黒感を伴うめまい症状を訴え，MRA と血管撮影で脳底動脈無描出，左鎖骨下動脈狭窄症，左椎骨動脈逆流現象および狭窄症を認めたため鎖骨下動脈盗血症候群と診断した．左鎖骨下動脈と椎骨動脈にステント治療を行った．左椎骨動脈の順行性血流は得られなかったが，症状は一時的に改善した． …
NAID 130004543332

Related Pictures

★リンクテーブル★

リンク元	「subclavian artery stenosis」
拡張検索	「subclavian steal syndrome」「subclavian steal症候群」
関連記事	「steal」「stealing」