Skip to Main Content

++

INTRODUCTION

++

When one discusses vascular diseases, a number of problems or situations may develop and require the patient to seek medical assistance. Most such problems may be readily recognized and many may be treated conservatively and successfully with little effort or risk. Some situations, however, may produce vague or confusing symptoms and thus may be very difficult to sort out or to diagnose. These patients may then see numerous physicians and have extensive evaluation before the correct diagnosis or therapy is appropriately delineated. Such a diagnostic and therapeutic challenge for physicians may be a patient with a steal syndrome (SS).

++

Patients present with the more classic, cerebral steal symptomatology in which the diagnosis was readily proven or established. We have also seen a number of individuals with vague, perplexing symptoms for evaluation and in whom eventually a steal syndrome was diagnosed. Those patients who have an established, symptomatic steal syndrome need to be provided the therapeutic options, including major invasive procedures or corrective surgery. Patients with asymptomatic incidentally encountered steal findings present a different situation. Many of these situations require little or no treatment and close periodic follow-up. Avoidance of major interventions and their potential complications may thus be minimized. The severely debilitating or acute life-threatening "steal" developments may require urgent or emergent intervention and the accompanying risk to preserve life or limb. Multiple considerations affect the ultimate therapy and prognosis for the patient (Table 47-1).

++
Table Graphic Jump Location
TABLE 47-1.

Steal Syndrome Considerations

++

DEFINITION

++

What is the definition of a steal syndrome? Different authors may ascribe different definitions or characteristics to this syndrome. A simple definition might be the taking of a blood supply from its usual direction and organ to another area as a result of a change in pressure gradient. This phenomenon can then occur in a number of situations. The classic example is where an artery is obstructed and the blood flow is then reversed in a vessel taking origin distal to the obstruction. The flow then travels around the obstruction and into the distal obstructed artery to serve the tissues distal to the obstruction. This may particularly occur when a greater need is recognized distally because of increased exercise or usage.

++

When this occurs, the blood, which originally flows away from the vessel obstructed, now flows toward the obstructed vessel and reverses the flow of blood into the circuitous route. This then redirects blood away from the original end-organ and provides the blood and nutrients to the ischemic or needy tissues. Thus, the original end-organ may receive a smaller supply of blood or nutrients. If the patient has findings on vascular study of blood flow redirection, or reversal, and the patient is asymptomatic, the ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessCardiology Full Site: One-Year Subscription

Connect to the full suite of AccessCardiology content and resources including textbooks such as Hurst's the Heart and Cardiology Clinical Questions, a unique library of multimedia, including heart imaging, an integrated drug database, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessCardiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.