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Right subclavian steal with steno-occlusive disease of the right subclavian artery

Simplified schematic of the aortic arch and great vessels showing typical collateral pathway to supply the right arm in the face of severe steno-occlusive disease of the proximal right subclavian artery (prior to the takeoff of the vertebral artery) (light green box). Flow is reversed in the right vertebral artery, and consequently blood is “stolen” from the vertebrobasilar circulation. Flow remains antegrade in the innominate (brachiocephalic) artery and the right common carotid artery. (Contributed and modified by Dr. Douglas Lanska. Greatly modified from original sketch in Owen E. A Manual of Anatomy for Senior Students. London and New York: Longmans, Green, and Co., 1890.)