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60 year old WM
Vascular US For Fainting Spell  

Doppler Evaluation of left Vertebral Artery. Dx?
What additional step can be taken during this study?
Same artery, after left arm exercise. Final Dx?

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Answers
Subclavian Steal Syndrome (partial)

  • Initial image (left), performed at rest, shows retrograde vertebral flow only during peak systole [partial steal]
  • Subsequent image (right) after arm excersise shows complete steal with retrograde flow throughout the cardiac cycle
  • Subclavian steal is caused by stenosis of the subclavian artery proximal to the origin of the vertebral artery, so that the vertebral artery functions as a collateral
  • Typically aquired: atherosclerosis (94%), dissection, arteritis, trauma,etc. symptoms of vertebrobasilar insufficiency

 

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