Subclavian Artery Stenosis

What is subclavian artery stenosis?

Subclavian artery stenosis is the narrowing of an artery that provides blood to your arm. This narrowing usually happens because of a buildup of plaque inside your artery (but there are multiple other causes). It’s like a speed bump inside your artery that slows down the blood moving through it.

When narrowing due to plaque buildup happens in your legs, people know it as peripheral artery disease (PAD). You can think of subclavian artery stenosis as a form of this condition.

Some people have symptoms, but many don’t because other arteries pick up the slack. They can send blood to your arm and make up for the slowdown in your subclavian artery.

Most people get subclavian artery stenosis on their left side. Because the left subclavian artery branches off from the aorta, it has more issues than the right one, which is a branch of a different artery.

Rarely, stenosis happens in both your left and right subclavian arteries.

How common is subclavian artery stenosis?

About 2% to 7% of people in the United States have subclavian artery stenosis. In people who’ve had peripheral vascular disease, it’s more like 19%. Subclavian artery stenosis happens more often in people assigned female at birth (AFAB).

What are the symptoms of subclavian artery atherosclerosis?

Subclavian artery stenosis symptoms may include:

• Muscle cramps when you use the affected arm.
• Arm pain or tiredness when you use the affected arm.
• Tingling or numbness (paresthesia) in the affected arm.
• Dizziness (rare).
• Fainting (rare).
• Vertigo (rare).

Most people don’t have symptoms because other blood vessels can supply enough blood to your arms. Symptoms develop slowly over time, showing up when you have a 50% narrowing in your artery. You can have other symptoms if you develop a steal syndrome.

What causes subclavian artery stenosis?

Causes of subclavian artery stenosis include:

1. Atherosclerosis (plaque buildup in your arteries; the most common cause).
2. Vasculitis.
3. Radiation (cancer treatment) of your chest.
4. Compression from thoracic outlet syndrome.
5. Takayasu’s arteritis.
6. Fibromuscular dysplasia.
7. Neurofibromatosis.

What are the risk factors for subclavian artery stenosis?

Risk factors for subclavian arterial stenosis include:

1. Being in your 50s or 60s.
2. Having high blood pressure (hypertension).
3. Having diabetes.
4. Having high cholesterol.
5. Eating foods with a lot of saturated or trans fat.
6. Using tobacco products.
7. Sitting too much and not exercising.
8. Having a body mass index (BMI) greater than 25.
9. Having peripheral artery disease in your legs.
10. Having Takayasu’s arteritis.

What are the complications of subclavian artery stenosis?

Subclavian artery stenosis complications may include:

1. Subclavian steal syndrome.
2. Coronary steal syndrome.
3. A piece of plaque breaking off, moving and getting stuck in a blood vessel closer to your fingers.
4. Lack of blood flow to your heart, brain or arm.
5. Transient ischemic attack (TIA).

How is subclavian artery stenosis diagnosed?

A healthcare provider will perform a physical exam, which includes checking your pulse and blood pressure. They may notice that one of your hands feels cool. When they look at your arms and hands, they may see that one of them has wounds that won’t heal because of a lack of blood flow. And they may find a weak pulse in one of your arms if you have subclavian artery stenosis.

Unlike a regular exam, they’ll check the blood pressure in both of your arms so they can compare them. If the blood pressure in one arm is more than 10 to 15 millimeters of mercury (mmHg) higher than the other, you may have subclavian artery stenosis. The blood pressure will be higher in the arm that gets blood from a healthy subclavian artery. (You have one on your left and one on your right.)

A provider may also hear a bruit, or whooshing sound, through their stethoscope. If they hear this when listening to your artery, it could be a sign of stenosis.

People with subclavian artery stenosis from uncommon causes show signs related to those conditions.

What tests will be done to diagnose subclavian artery stenosis?

If your provider thinks you may have subclavian arterial stenosis, they can use an ultrasound device to check your blood flow. They can also order these tests to look at your blood vessels, like:

• Computed tomography (CT) angiogram.
• Magnetic resonance angiogram (MRA).
• Traditional (invasive) angiogram, sometimes using a technique that makes it easier to see blood vessels. This method, digital subtraction, makes unrelated body parts like bones less visible on an image.

What is the treatment for subclavian artery stenosis?

People who have symptoms may need:

1. Aspirin.
2. Cholesterol-lowering medicines.
3. Medicine for high blood pressure.
4. Medication for vasculitis, if that’s the cause.
5. Angioplasty, possibly with a stent, to open the artery.
6. Bypass surgery (in rare cases) to improve blood flow by using another artery to go around the blocked one.

Even if you don’t have symptoms, your provider will want to address the buildup in your arteries that’s causing the narrowing. This plaque buildup can happen in many areas of your body and lead to a stroke or heart attack. They’ll most likely ask you to:

• Be physically active for at least 30 minutes on most days of the week.
• Stay at a weight that’s healthy for you.
• Avoid tobacco products.
• Eat foods that are low in saturated and trans fats.

Complications/side effects of the treatment

Any medication can have side effects. Talk with your healthcare provider if you have lasting side effects that bother you.

Complications from a procedure may include:

1. Bleeding.
2. Damage to a blood vessel.
3. Blood clots.
4. A stent may not expand enough or may not be in exactly the right place.
5. A stent a provider puts in your artery can break.
6. A blockage can develop in an artery again.
7. Rarely, people can have a stroke after angioplasty or surgery.

How long does it take to recover from this treatment?

You’ll need to rest for a day or so after angioplasty. You may be able to drive and go back to work in a week or less. The recovery time for bypass surgery is longer. Your provider can let you know what to expect based on your situation.

Can subclavian artery stenosis be prevented?

Yes, you can prevent the plaque buildup that causes subclavian arterial stenosis. You can do this by changing how much physical activity you get and what kinds of foods you eat, as well as other things listed above. It’s also important to treat other conditions you have, like:

• High cholesterol.
• High blood pressure.
• Diabetes.

What can I expect if I have subclavian artery stenosis?

Treatments work well for opening your subclavian artery if you have symptoms. If you don’t have symptoms, you don’t need treatment.

But with or without symptoms, subclavian artery stenosis is a warning sign. In most cases, atherosclerosis causes it. If you have plaque buildup from cholesterol in one artery, you probably have it in others. This is why your provider will want you to focus your energy on managing the risk factors for cardiovascular (heart and blood vessel) disease.

This includes no longer using tobacco products, if you do, and managing or avoiding:

• High blood pressure.
• High cholesterol.
• Diabetes.

Outlook for subclavian artery stenosis

Angioplasty has more than a 95% success rate for getting rid of symptoms. Five years after angioplasty, the formerly blocked artery is usually still 90% open. Open surgery may give you results that keep your artery open even longer.

Your outcome may be worse if you have a complete blockage in your artery.

How do I take care of myself?

The same lifestyle changes you can take to prevent subclavian artery stenosis will help you after treatment. Healthy habits can keep stenosis from developing again. If a provider puts a stent in your artery, you’ll most likely take aspirin and clopidogrel to prevent the stent from closing off.

When should I see my healthcare provider?

You should see your provider every six months for the first two years after treatment. Then, you can see them once a year. This will vary by practice. Follow your provider’s follow-up instructions.

When should I go to the ER?

People who have subclavian artery stenosis may have plaque buildup in other blood vessels. These can include arteries that supply your heart with blood. A blockage in your coronary arteries can lead to a heart attack. If you have symptoms of a heart attack, get immediate medical help.

Heart attack symptoms may include:

1. Chest pain.
2. Shortness of breath.
3. Lightheadedness.
4. Heart palpitations.
5. Upset stomach.

What questions should I ask my doctor?

Questions you may want to ask your healthcare provider include:

• Do I need treatment?
• What kind of treatment is best in my case?
• How many of these procedures does your facility perform each year?
• Can you refer me to a provider who can help me develop heart-healthy habits?

Is subclavian artery stenosis dangerous?

It can be dangerous if it leads to a steal syndrome that takes blood meant for your heart or brain and sends it to your arm instead. These conditions can happen as a result of subclavian artery stenosis. The best thing you can do to avoid these issues is to follow your provider’s advice on starting or improving healthy eating and exercise habits.

A note from Cleveland Clinic

Finding out that you have stenosis in your subclavian artery may be the first time you’ve heard of that blood vessel. But consider it a message from your body: You have atherosclerosis. If you have it in one artery, you can have it in others, too. Take charge of your future by taking steps now to make your heart and blood vessels healthier.