Concealed Subclavian Steal Syndrome: The Story of Labile Hypertension and Omarthrosis

Background/Objectives: Occlusion of the subclavian artery, often associated with subclavian steal syndrome (SSS), presents significant diagnostic and therapeutic challenges. This occlusion typically results in retrograde blood flow from the vertebral artery, manifesting clinically as ischemia in various regions supplied by branches of the affected artery. High-grade stenosis (≥75%) or complete occlusion usually precedes symptoms, where inadequate collateral circulation leads to significant hemodynamic disturbances. Case presentation: This case report delves into the case of an 87-year-old woman with a significant medical history, including universal atherosclerosis, dementia, a surgically treated uterine adenocarcinoma, hypertension, and glenohumeral arthritis with a history of several hospitalisations over the past decade due to ISMN-related collapses. Omarthrosis played a key role and posed a diagnostic challenge in masking a severe vascular issue. Results: Due to comprehensive diagnostic efforts, the contributing aetiology was identified – subclavian steal syndrome resulting from the severe stenosis of the right subclavian artery. This case highlights the importance of a thorough investigation and differential diagnosis in older patients. Conclusions: In the geriatric population, it is essential to consider not only common causes of weakness, such as age-related sarcopenia or overweight/obesity, known cardiovascular issues, and neurodegenerative disorders, but also less frequent conditions that might overlap.