verteral artery

Sonography of the Vertebral Arteries
A Window to Disease of the Proximal Great Vessels
Mindy M. Horrow1 and John Stassi
+ Author Affiliations

1 Both authors: Department of Radiology, Albert Einstein Medical Center, 5501 Old York Rd., Philadelphia, PA 19141.

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Fig. 1. —Normal anatomy of aortic arch and great vessels. Diagram of normal anatomy of aortic arch and great vessels shows brachiocephalic artery (1), right common carotid artery (2), right subclavian artery (3), right vertebral artery (4), left common carotid artery (5), left subclavian artery (6), and left vertebral artery (7).

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Fig. 2. —Normal vertebral artery of 45-year-old man. Sagittal color and duplex Doppler sonograms show vertebral artery below vertebral vein, both visualized between shadows from transverse processes of spine (arrows).

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Fig. 3A. —Left subclavian steal. Diagram shows occlusion of left subclavian artery proximal to origin of left vertebral artery. Arrows show direction of flow is antegrade in right vertebral artery and retrograde in left vertebral artery.

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Fig. 3B. —Left subclavian steal. Sonogram of 66-year-old woman with severe diffuse atherosclerotic disease and markedly decreased blood pressure in left arm shows left vertebral artery flow to be reversed.

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Fig. 4A. —Right subclavian steal caused by right subclavian occlusion. Diagram shows occlusion of right subclavian artery proximal to origin of right vertebral artery. Arrows show direction of flow is antegrade in left vertebral artery and retrograde in right vertebral artery. Flow in right common carotid artery is unaffected.

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Fig. 4B. —Right subclavian steal caused by right subclavian occlusion. Sonogram of 81-year-old woman with significantly decreased blood pressure in right arm shows right vertebral artery flow to be reversed.

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Fig. 4C. —Right subclavian steal caused by right subclavian occlusion. Sonogram of patient seen in B with normal right common carotid artery waveform.

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Fig. 5A. —Right subclavian steal caused by brachiocephalic occlusion. Diagram shows occlusion of brachiocephalic artery. Arrows show direction of flow is antegrade in left vertebral artery and retrograde in right vertebral artery, which then supplies subclavian artery and collateral antegrade flow to right common carotid artery.

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Fig. 5B. —Right subclavian steal caused by brachiocephalic occlusion. Sonogram of 72-year-old woman with significantly decreased blood pressure in right arm and transient ischemic attacks shows right vertebral artery flow to be reversed.

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Fig. 5C. —Right subclavian steal caused by brachiocephalic occlusion. Sonogram of same patient (B) with abnormal waveform showing tardus parvus pattern in antegrade direction. Right internal carotid artery waveform (not shown) was similar.

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Fig. 6A. —Partial subclavian steal. Diagram shows significant stenosis of left subclavian artery proximal to origin of left vertebral artery. Flow in left vertebral artery (short arrows) varies between antegrade and retrograde. Flow is always antegrade in right vertebral artery (long arrow).

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Fig. 6B. —Partial subclavian steal. Sonogram of 60-year-old man with diminished pulses and blood pressure in left arm shows left vertebral artery flow to be bidirectional. Following brief antegrade acceleration (small arrow) retrograde flow occurs during systole (curved arrow). Antegrade flow returns during diastole (large arrow).

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Fig. 6C. —Partial subclavian steal. Sonogram of same patient (B) with blood pressure cuff applied to left arm and inflated to greater than systolic pressure for 3 min. After cuff release, increase in reversed component (arrow) is due to reactive hyperemia in arm.

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Fig. 6D. —Partial subclavian steal. Sonogram of same patient (B and C) after successful left subclavian angioplasty shows that left vertebral artery waveform returns to normal.

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