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Retrograde Flow in the Vertebral Artery

Arch Surg. 1965;91(1):185-194. doi:10.1001/archsurg.1965.01320130187022.
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Introduction  N UMEROUS collateral pathways develop to maintain the circulation to the arm following occlusion of the proximal subclavian or innominate artery.2,8,9,11 Under certain circumstances, all branches of the proximal subclavian artery, certain branches of the external carotid artery, and even the internal carotid artery may supply blood to the ischemic arm. The vertebral artery, however, because of its size and direct connection to the contralateral vertebral at its junction with the basilar artery, is the most important of these. The reversal of vertebral artery flow which occurs with proximal subclavian artery occlusive lesions may deprive the brain of sufficient arterial blood flow so that significant neurological manifestations result.14 The terms "subclavian steal syndrome"4 and "brachial-basilar insufficiency syndrome"10 have been used in reference to this association and are descriptive of the hemodynamic alterations which occur.A review of our arteriographic experience in patients with symptoms and/or


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