Subclavian Stenosis

Peripheral vascular disease (PVD) is often a systemic process affecting all of the blood vessels in the body. Plaque builds up slowly in the extremities. The legs and carotid arteries are the most commonly affected, but the upper extremities can also be affected. The subclavian artery supplies blood to the left upper extremity and the posterior aspect of the left side of the brain via the vertebral artery.

When a patient has a subclavian stenosis there can be a myriad of symptoms. The most common symptom is arm pain. Patients will complain of a cramp-like pain or fatigue in the left arm when brushing their hair or teeth. This discomfort is caused directly by low blood flow to the muscles. The blood supply from the opposite arm will eventually supply the left side via redundant circulation from the vertebral artery. This is known as subclavian steal. This causes patients to complain of right-sided headaches from the blood flowing through their cerebral circulation. If a patient has a narrowing in the right vertebral artery and a subclavian stenosis, he can be at risk for stroke to the posterior aspect of the brain.

In the vast majority of cases, a subclavian stenosis can be repaired by insertion of a vascular stent. The procedure can be done via the leg and is very effective and durable. If the artery is 100 percent occluded, the chance of a successful procedure is lower. The most significant risk of the procedure is stroke or dissection of the aorta. Stroke is rare if the arm is receiving blood flow via the right-sided circulation, as the direction of flow prevents material from embolizing to the posterior aspect of the brain. Dissection or tearing of the aorta can be fatal if it extends to the heart and affects the coronary arteries. After a stent procedure in the subclavian artery, patients must take Plavix and aspirin for at least a month, although many doctors recommend taking Plavix indefinitely. All patients with PVD should receive aggressive medical treatment with anti-platelet agents, statins and blood pressure control. Smoking is a major risk factor for PVD and smoking cessation is recommended or all patients with PVD.