양팔의 혈압 차이로 발견한 빗장밑 동맥 도루 증후군 (Subclavian Steal Syndrome)을 스텐트 삽입술로 치료한 환자 증례
A Case of Successful Correction of Subclavian Steal Syndrome by Percutaneus Transluminal Angioplasty with Stenting Who Found Incidentally Signifi cant Interarm Blood Pressure Difference
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양팔의 혈압은 정상인에 있어서도 약간씩만 차이가 있을 수 있으나 그 차가 심할수록 동맥경화증으로 인한 빗장밑 동맥 의 협착을 비롯한 말초 혈관 질환을 시사하고, 심혈관계 질환 의 이환율과 사망률이 높아진다. 빗장밑 동맥 도류 증후군은 말초 동맥 질환의 일종으로 빗장밑 동맥의 협착으로 인하여 나타난 현상을 의미하며, 가장 흔한 원인은 동맥경화증이다. 증상은 뇌기저부 허혈 증상과 병변측의 상지 허혈증상으로 나타내고, 치료는 수술적 방법과 혈관 중재 시술을 통하여 혈 류를 재개한다. 저자들은 힘든 작업 후에 어지러움, 말이 꼬이 는 증상을 주소로 내원한 42세 남자 환자에서 양팔의 수축기 혈압이 차이가 35 ㎜Hg으로 차이를 보여 검사한 결과 빗장 밑 동맥 도류 증후군을 진단하고 비교적 간단하게 요골 동맥 (radial artery)을 통하여 경피적 혈관 성형술로 스텐트를 삽입 하여 좋은 결과를 얻어 문헌 고찰과 함께 보고하는 바이다.
Abstract
A case of successful correction of subclavian steal syndrome by percutaneous transluminal angioplasty with stenting in a male patient who found incidentally signifi cant interarm blood pressure difference. Small difference in blood pressure (BP) between two arms is a relatively common. Significant interarm BP difference is a potential marker of peripheral vascular disease such as subclavian artery stenosis and a predictor of cardiovascular disease. The subclavian steal syndrome is a condition that results from stenosis of subclavian artery proximal to the vertebral artery. The resulting symptoms are vertebrobasilar insuffi ciency symptoms due to reversal of blood flow from the contralateral vertebral and basilar artery into the ipsilateral upper extremity vessels and arm ischemic symptoms. Stenotic lesion of subclavian artery has traditionally been treated surgically. However recent trends are undergoing a paradigm shift from open surgery to endovascular approach. We report a patient with subclavian steal syndrome who found incidentally 35 ㎜Hg interarm systolic BP difference. It was successfully treated by percutaneus transradial angioplasty with stenting on stenotic lesion of the subclavian artery.
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