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Syncope with right subclavian double steal syndrome (duplex ultrasonography) (2)

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Duplex ultrasonography of the right internal carotid artery depicting the biphasic antegrade blood flow during cardiac systole and retrograde blood flow towards the right subclavian artery during cardiac diastole (subclavian-carotid steal syndrome). The patient was a 73-year-old man who presented for the evaluation of dizziness and episodes of syncope and was found to have right subclavian double steal syndrome. Innominate artery occlusion proximal to the origin of the common carotid and vertebral arteries may result in retrograde blood flow in one or both of these vessels and preferential blood flow into the low-pressure ipsilateral arm vessels during exercise (or even at rest), depending on the presence of collateral flow and on the relative resistance of the vascular beds. (Source: Filis K, Toufektzian L, Sigala F, et al. Right subclavian double steal syndrome: a case report. J Med Case Rep 2008;2:392. Creative Commons Attribution 2.0 Generic [CC BY 2.0] license, creativecommons.org/licenses/by/2.0.)