Hemodynamics of the Upper Extremities in Subclavian Steal Syndrome

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Abstract
Digital flow, digital artery systolic pressure, resistance, pulse volume, pulse contour, and delay between right and left pulses were evaluated in the upper extremities of four patients with the subclavian steal syndrome. Studies were made preoperatively in all patients and following surgical reconstruction of the subclavian in three cases. Digital artery pressures were consistently lower on the side with the subclavian occlusion. Flow on the occluded side was equal to or higher than that in the opposite extremity except when a second, more distal occlusion was present. In each case there was a delay in the foot of the digital pulse on the occluded side and a more marked delay in the pulse peak. Distal to the occlusion the pulse amplitudes were decreased and the contours were abnormal. The amplitude of the digital pulse was markedly decreased with exercise of the affected extremity. The pulse delay and the disappearance of pulse in the radial artery during exercise previously described clinically has been confirmed by measurement.