[Subclavian steal syndrome. Bypass surgery or percutaneous transluminal angioplasty].

The authors are presenting two patients with subclavian steal syndrome successfully treated by axillo-axillary bypass or by percutaneous transluminal angioplasty, and discuss the choice of procedures for the correction of the subclavian steal syndrome. The first patient was a 48-year-old man complaining of easy fatiguability of the right arm and ver tigo. No neurological abnormality was found, but the blood pressure was 160/90 mmHg in the left arm and 120/90 in the right. Angiograms revealed complete occlusion of the innominate artery and retrograde filling of the right vertebral artery. Axillo-axillary bypass was performed using 8F Dacron velour graft under general anesthesia. After surgery, the patient was free from any symp toms and the patent axillo-axillary bypass and antegrade flow of right vertebral artery were observ ed on postoperative angiograms. The second patient was a 58-year-old man who experienced an episode of motor weakness of the left upper and lower extremities and speech disturbance 8 years before admission. Although neurological examination was within normal limits except for a slight left hemiparesis and there was no difference between the blood pressure values measured in either arm, angiograms showed com plete occlusion of the left subclavian artery at the proximal portion and a moderate stenosis at the distal portion as well as retrograde filling of the left vertebral artery. Following angiography, per cutaneous transluminal angioplasty was performed at the occlusive and stenotic portions. Recanalization of the occluded proximal subclavian artery with smooth vessel wall contours and reduction of a stenosis at the distal portion were observed in the postangioplasty angiograms. It is suggested that percutaneous transluminal angioplasty can be safely applied to occlusive le sions of the left subclavian artery with the retrograde flow of the left vertebral artery.