同: 鎖骨下動脈盗血症候群

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
a pattern of symptoms indicative of some disease
a complex of concurrent things; "every word has a syndrome of meanings"
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
(疾患の徴候となる一群の)症徴候,症候群 / (事件・社会的状態などのパターンを示す)徴候形態
〈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）』「2013/02/12 13:47:53」(JST)

wiki en

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

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

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

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)

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

Atherosclerosis
Cervical rib
Takayasu's arteritis

Signs and symptoms

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

Stroke

Diagnostic tests

Doppler ultrasound
CT angiography
Angiogram

Treatment

Stent and balloon angioplasty
Endarterectomy

References

^ 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. 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

Subclavian Steal Syndrome - emedicine.com

UpToDate Contents

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1. 鎖骨下動脈盗血症候群 subclavian steal syndrome
2. 上肢末梢動脈疾患の概要 overview of upper extremity peripheral artery disease
3. 高安動脈炎の臨床的特徴および診断 clinical features and diagnosis of takayasu arteritis
4. 後方循環系の脳血管症候群 posterior circulation cerebrovascular syndromes
5. ファロー四徴症のマネージメントおよび転帰 management and outcome of tetralogy of fallot

English Journal

Intraoperative left subclavian artery occlusion with left hand ischaemia and steal syndrome in the left internal thoracic artery.

Jelenc M, Knezevic I, Stankovic M, Gersak B.SourceDepartment of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Interactive cardiovascular and thoracic surgery.Interact Cardiovasc Thorac Surg.2012 Oct;15(4):772-3. Epub 2012 Jul 5.
We present a case of a 62-year old man with a left main stenosis, left coronary artery dominance, normal ejection fraction and no valvular pathology, and status post right carotid artery stenting, who was scheduled for elective coronary revascularization. We performed off-pump coronary revasculariza
PMID 22767542

A new form of coronary subclavian steal syndrome: a saphenous vein graft-coronary-subclavian unidirectional steal syndrome.

Ozkan B, Açar G, Cakalagaoglu KC, Koksal C, Esen AM.SourceDepartment of Cardiology, Kartal Kosuyolu Yuksek Ihtisas Heart-Education and Research Hospital, Istanbul, Turkey.
The heart surgery forum.Heart Surg Forum.2012 Aug 1;15(4):210-1.
Coronary subclavian steal syndrome refers to decreased or reversed internal mammary artery flow, which causes angina related to severe subclavian steno-occlusive disease in patients with in situ internal mammary-to-coronary artery graft. We present a 48-year-old man with cerebrovascular and peripher
PMID 22917819

Japanese Journal

鎖骨下動脈盗血症候群に対するPTA/stentの効果 : SPECTによる脳血流評価

石原秀行,岡史朗,白尾敏之,貞廣浩和,加藤祥一,黒川徹,大石誉奈,前田佳彦,東真由,鈴木倫保
脳神経外科ジャーナル 20(7), 519-522, 2011-07-20
【目的】鎖骨下動脈盗血症候群の脳循環動態の特徴を調べるために,脳循環動態をdual table ARG法を用いて評価を行った.【対象と方法】2006年からの3年間にPTA/stentを施行した鎖骨下動脈盗血症候群9例を対象とした.全例,治療前と治療後6ヵ月にdual table ARG法による脳血流定量を行った.【結果】治療前の脳血流予備能(%)は,大脳で40.8±18.4%に対し,小脳で26.9 …
NAID 110008673600

鎖骨下動脈盗血症候群に対して総大腿動脈を inflow とする両上肢への非解剖学的バイパス術を施行した1手術例

森下篤,冨岡秀行,片平誠一郎
日本血管外科学会雑誌 = The Japanese journal of vascular surgery : official journal of the Japanese Society for Vascular Surgery 20(4), 721-724, 2011-06-25
NAID 10029537579

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リンク元	「鎖骨下動脈盗血症候群」「subclavian artery stenosis」「subclavian steal」
関連記事	「subclavian steal」「steal syndrome」「syndrome」「steal」「stealing」