Brief clinical report| Volume 75, ISSUE 2, P299-304, February 1974

A simplified correction of subclavian steal syndrome

      This paper is only available as a PDF. To read, Please Download here.


      A simple cross-axillary artery bypass is being proposed as therapy for the subclavian steal syndrome. In subclavian artery occlusion, blood flows retrogradely through the vertebral artery to supply blood to the arm, thus stealing blood from the head and causing brain ischemia. The problem is to supply blood to the arm and subclavian artery with sufficient pressure to profuse the arm and, in addition, provide prograde flow in the vertebral artery. A vein graft or prosthesis is attached to the good axillary artery and brought across the chest to the contralateral side. The second and third parts of the axillary artery are exposed at the shoulder. The bypass is anastomosed to the third part of the axillary artery on each side. The graft is pulled through a split in the pectoralis major muscle and through a subcutaneous tunnel created on the chest wall to the opposite side. Operations performed in the neck and behind the clavicle utilize the good ipsolateral carotid artery as the source of blood for revascularization of vertebral or subclavian artery. Intrathoracic operations may be of more serious consequence than the disease. Even the clavicle-splitting operations are of appreciable magnitude and produce prolonged disability. Utilization of the good carotid artery imposes the added risk of serious brain ischemia during surgery and postoperatively. The simplicity of the procedure and the excellent long-term clinical result obtained with axillary-to-axillary artery bypass makes it the procedure of choice.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Clark K.
        • Perry M.D.
        Carotid vertebral anastomosis: An alternate technique for repair of the subclavian steal syndrome.
        Ann. Surg. 1966; 163: 414
        • Craddock D.R.
        • Logan A.
        The subclavian steal and its surgical management.
        Br. J. Surg. 1966; 53: 926
        • Daicoff G.R.
        • Lancaster J.R.
        • Ranniger K.
        • Moulder P.V.
        Rationale for aortosubclavian artery bypass.
        J. Thorac. Cardiovasc. Surg. 1965; 49: 945
        • Dumanian A.V.
        • Frahm C.J.
        • Pascale L.R.
        • Teplinsky L.L.
        • Santschi D.R.
        The surgical treatment of the subclavian steal syndrome.
        J. Thorac. Cardiovasc. Surg. 1965; 50: 22
        • Folger G.U.
        • Shah K.D.
        Subclavian steal in patients with Blalock-Taussig anastomosis.
        Circulation. 1965; 31: 241
        • Harper J.A.
        • Golding A.L.
        • Mazzei E.A.
        • Cannon J.A.
        An experimental hemodynamic study of the subclavian steal syndrome.
        Surg. Gynecol. Obstet. 1967; 124: 1212
        • Javid H.
        • Julian O.C.
        • Dye W.S.
        • Hunter J.A.
        Management of cerebral arterial insufficiency caused by reversal of flow.
        Arch. Surg. 1965; 90: 634
        • Killen D.A.
        • Foster J.H.
        • Gobbel Jr., W.G.
        • Stevenson S.E.
        • Collins H.A.
        • Billings F.T.
        • Scott Jr., H.W.
        The subclavian steal syndrome.
        J. Thorac. Cardiovasc. Surg. 1966; 51: 539
        • Murray D.S.
        Post-traumatic thrombosis of the internal carotid and vertebral arteries after non-penetrating injuries of the neck.
        Br. J. Surg. 1957; 44: 556
        • North R.R.
        • Fields W.S.
        • De Bakey M.E.
        • Crawford E.S.
        Brachial-basilar insufficiency syndrome.
        Neurology. 1962; 12: 810
        • Parrott J.C.
        The subclavian steal syndrome.
        Arch. Surg. 1964; 88: 661
        • Piccone Jr., V.A.
        • LeVeen H.H.
        Collective review. The subclavian steal syndrome.
        Ann. Thorac. Surg. 1970; 9: 1
      1. Piccone, V. A., Karvounis, P., and LeVeen, H. H.: The subclavian steal syndrome, Angiology. In press.

        • Rob C.
        Incipient strokes: Technique of surgical therapy.
        in: Millikan C.H. Siekert R.G. Whisnant J.P. Cerebral vascular diseases. Grune & Stratton, Inc, New York1961: 112
        • Rojas R.H.
        • Levitsky S.
        • Stansel H.C.
        Acute traumatic subclavian steal syndrome.
        J. Thorac. Cardiovasc. Surg. 1966; 51: 113
        • Webb W.R.
        • Burford T.H.
        Gangrene of arm following use of subclavian artery in a pulmonosystemic anastomosis.
        J. Thorac. Surg. 1952; 23: 199
        • Wheeler H.B.
        Surgical treatment of subclavian artery occlusions.
        N. Engl. J. Med. 1967; 276: 711