SOMANZ Poster Presentation Australasian Diabetes in Pregnancy Society and Society of Obstetric Medicine Australia and New Zealand Joint Scientific Meeting 2025

Subclavian steal phenomenon as a presentation of Takayasu Arteritis  (#164)

Annabel AL Lo 1 2 , Sarah SS Sadique 1 2 , Elvina EI Ingrid 1 2 , Briony BC Cutts 1 3
  1. Department of Maternal Fetal Medicine, Joan Kirner Women’s and Children’s Hospital, Melbourne, VIC, Australia
  2. Department of Obstetrics, Joan Kirner Women’s and Children’s Hospital, Melbourne, VIC, Australia
  3. Department of Haematology, Royal Women’s Hospital, Melbourne, VIC, Australia

Abstract 

Aim: Given the possible adverse consequences of subclavian steal syndrome (SSS) in pregnancy, we undertook a case report and literature review to establish better standards of management. 

Method: A scoping review of the literature was undertaken using the words “Subclavian steal syndrome” and “pregnancy”. The patient’s clinical, examination and investigations are summarised. 

Results: An asymptomatic 31-year-old Indian primigravida at 29 weeks was found to have blood pressure discrepancy of more than 20mmHg and SpO2 differences in both arms. On examination, she was normotensive and had no left radial pulse. A pan-systolic murmur and bilateral carotid bruit were auscultated. 

Carotid Doppler showed multifocal arterial narrowing in the bilateral common carotid artery and left subclavian artery. Flow was reversed in the left vertebral artery, which suggests subclavian steal phenomenon (SSP). 

CT chest revealed widespread arterial wall thickening consistent with large vessel vasculitis. CT brain showed no intracranial aneurysm. She did not tolerate the non-contrast MRI due to claustrophobia. Takayasu’s arteritis (TA) was the working diagnosis. 

Her 37-week growth scan revealed oligohydramnios and IUGR (EFW 4%). She subsequently delivered a 2.6 kg baby by elective caesarean at 38 weeks. Given her thromboembolic risk, she was on extended prophylactic Clexane postpartum. 

Conclusion: SSS refers to the cerebral ischaemic symptoms from reversed flow within the vertebral artery. Without symptoms, it is known as SSP1. Differentials include subclavian artery compression, cervical rib and, in young Asian females, TA. SSS could be managed with antiplatelets, anticoagulants and/or surgery depending on the severity2. 

 

 

  1. Osiro S, Zurada A, Gielecki J, Shoja MM, Tubbs RS, Loukas M. A review of subclavian steal syndrome with clinical correlation. Med Sci Monit 2012 May; 18(5):RA57-63. doi: 10.12659/msm.882721. PMID: 22534720; PMCID: PMC3560638.
  2. Patel DJ, Chaudhari K, Gupta A, Patel N, Patel PP. Navigating Subclavian Artery Stenosis in Pregnancy: A Multidisciplinary Approach to a High-Risk Case. Cureus 2023 Aug; 15(8):e43933. doi: 10.7759/cureus.43933. PMID: 37746358; PMCID: PMC10513350.