鎖骨下動脈狹窄或阻塞(subclavian artery stenosis or occlusion)會引起同側脊椎動脈血液 逆流而導致鎖骨下竊血症候群(subclavian steal syndrome)，大部分的病人沒有症狀，而症狀 以頭暈、不平衡來表現，老年、糖尿病、高血壓、高血脂為此疾病的危險因子。頭暈是老 年人常見的症狀之一，但常為非特異性症狀，加上老年人容易患有多重疾病，頭暈有時不 明顯，往往不是主要症狀之一，而容易被忽略掉，無法發現隱藏的疾病。 本病例是一位77歲女性，過去沒有任何病史，一開始門診主述為2個月內體重減輕5公 斤，合併多吃、多喝、多尿等症狀，經檢驗診斷為糖尿病，糖化血色素(HbA1c)高達18.8 %，當下血壓測量為150/83 mmHg，醫師建議在家監測記錄血壓。兩個禮拜後回診，家屬發 現病人兩手血壓差異很大，於是當診再次測量左右上臂血壓，發現收縮壓差異達60 mmHg，細問之下，病人才說平時偶爾也會頭暈，經杜普勒超音波與摶動容積記錄檢查，診 斷為左鎖骨下動脈狹窄，最後經心導管檢查，診斷為左鎖骨下動脈完全阻塞並置放血管支 架。本文希望藉此病例及文獻回顧，針對高危險族群的老年病患(如糖尿病、高血壓、高血 脂)，縱使無頭暈症狀，應常規測量兩側上臂血壓差異，初步篩選鎖骨下動脈狹窄，提早治 療與預防，降低併發心血管與腦血管疾病的風險。

Subclavian artery stenosis or occlusion may cause ipsilateral vertebral arterial retrograde blood flow and induce subclavian steal syndrome. Most of these patients don’t have symptoms. If they have symptoms, the symptoms are often dizziness and unbalanced. Elderly, diabetes, hypertension and dyslipidemia are the risk factors of this disease. Dizziness is one of the common symptoms for elderly but is non-specific symptom. Elderly easily suffer from multiple disease and dizziness isn’t obvious symptom and major symptom for them. Therefore, dizziness is easily ignored and we can’t find these hidden diseases. We report a 77-year-old female without any systemic disease. At the beginning, her chief complaint was body weight loss(5kg) within 2 months. She also had polyphagia, polydipsia and polyuria. She received blood lab test and diabetes was diagnosed. The HbA1c was 18.8% and blood pressure was 150/83 mmHg. The doctor suggested this patient monitoring and recording home blood pressure.2 weeks later, family noticed the patient’s blood pressure were very different on bilateral arms. Therefore, the doctor checked the blood pressure of bilateral arms and found the difference was up to 60 mmHg. After advanced taking history, the patient also suffered from dizziness occasionally. Then she received doppler extremity and pulse volume record and left subclavian artery stenosis was suspected. Then she received cardiac catheterization and left subclavian artery total occlusion was diagnosed. She received successful percutaneous transluminal angiography with Express Stent. By this case and journals review, for elderly with high risk factors (diabetes, hypertension, dyslipidemia) even without dizziness, we suggest check brachial systolic pressure difference routinely for early detection of subclavian artery stenosis. Then they could receive early treatment and prevention to reduce the risk of cardiovascular and cerebrovascular disease.