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Did you ask the patient if they are symptomatic and at what level of
exercise if they are?  If they are not symptomatic the basic philosophy is
usually leave it alone, collaterals will typically compensate.  The fact
that the vertebral flow is antegrade at rest indicates fair
collateralization already in place with such a significant pressure
gradient.  An individual would have to exercise quite vigorously to
replicate 3 minutes of ischemia.  Most individuals do not apply that much
stress to the upper extremity unless at a barbeque with free beer, or if
they change light bulbs for a living.

…TJ


-----Original Message-----
Subject: sublcavian steal

subclavian stenosis with 70 mm pressure gradient
antegrade vertebral at rest
retrograde vertebral S/P 3 min cuff ischemia

radiologist says "So what!  This does not mean he would steal with
exercising the arm."

Any thoughts on how cuff ischemia correlates with arm use?

Thanks, Nancy Stiglbauer

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