Vertebrobasilar insufficiency after subclavian flap aortoplasty for aortic coarctation

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Vascular Surgery

Background:

• Open surgery remains the primary treatment for pediatric aortic coarctation.
• Subclavian flap aortoplasty, described in 1966, is a surgical option for aortic coarctation repair.
• Modifications to the technique have evolved with long-term follow-up data.

Observation:

• Early outcomes of subclavian flap aortoplasty showed minimal concern for limb ischemia or subclavian steal syndrome.
• These complications, though rare, can manifest years after the initial coarctation repair.
• This report details a case of subclavian steal syndrome presenting 36 years post-surgery.

Findings:

• The patient experienced severe, lifestyle-limiting vertebrobasilar symptoms.
• Symptoms were attributed to subclavian steal syndrome, a delayed complication of the aortoplasty.
• This case highlights the potential for late-onset complications following this surgical procedure.

Implications:

• Delayed subclavian steal syndrome requires consideration in the long-term management of patients who underwent aortic coarctation repair.
• Increased awareness among clinicians is crucial for timely diagnosis and intervention.
• Further research into risk factors and preventative strategies for late complications is warranted.