Subclavian steno-occlusive disease proximal to the vertebral artery is associated with reversal of flow that may lead to vertebrobasilar insufficiency. Usually asymptomatic, but may present with transient ischemic attacks, arm claudications, or both. Diagnosis is made incidentally during Doppler ultrasound examination of the carotid and vertebral arteries.
Study of 22 patients with diagnostic evidence of retrograde flow in the vertebral artery due to stenosis or occlusion of the ipsilateral subclavian artery. 15 males and 7 females with age range between 44-73 years were included in this study.

Symptoms were arm claudication in 13 patients, syncope and dizziness in 3 and the remaining 6 patients were asymptomatic and discovered during duplex study for neck bruit duplex study. Treatment modalities used were Axillo-axillary bypass in 6 cases and carotid-subclavian bypass in 7 cases and angioplasty and stenting in the last 9 cases.

Clinical results were compared and proper indications of each modality were defined.

In conclusion: Subclavian steal syndrome is a rare clinical syndrome. The main etiology among our population is atherosclerosis. Patients usually present with arm claudications and rarely with transient ischemic attacks due to vertebrobasilar insufficiency. Investigation of neck bruit help in diagnosis of more cases. Surgical revascularization can be made with excellent outcome and long term patency rate. The new modality of angioplasty and stenting provides an excellent alternative to such patients with minimal rate of morbidity and mortality.