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Subclavian steal syndrome in the pediatric age group
Insights
Subclavian steal syndrome (SSS) in children can persist after aortic arch repair. Surgical interventions like vertebral artery ligation or arterioplasty effectively treated SSS in four pediatric cases.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Vascular Surgery
Background:
- Subclavian steal syndrome (SSS) is a rare condition affecting blood flow to the arm.
- Congenital or acquired SSS can complicate surgical repair of aortic arch anomalies in pediatric patients.
Observation:
- Four pediatric cases of SSS are presented, detailing congenital and acquired forms.
- Contributing factors included hypoplastic aortic arch, vertebral artery origin variations, and recurrent coarctation.
- One patient had persistent SSS post-coarctation repair due to aortic arch hypoplasia.
Findings:
- Three patients developed acquired SSS after surgical correction for coarctation or interrupted aortic arch.
- Vertebral artery ligation was performed in three patients, and prosthetic patch arterioplasty in one.
- All four patients remained asymptomatic following surgical management.
Implications:
- Early identification and tailored surgical strategies are crucial for managing SSS in pediatric patients with aortic arch disease.
- Vertebral artery ligation and arterioplasty are effective treatments for SSS in this population.
- Successful management of SSS ensures favorable long-term outcomes in pediatric cardiovascular surgery.
Abstract:
Four pediatric patients with subclavian steal syndrome (SSS) are described. One patient with congenital SSS had persistence of the lesion following surgical repair of coarctation of the aorta due to a gradient across a hypoplastic aortic arch. In 3 patients SSS developed on an acquired basis as a sequel to corrective operation, for coarctation in 1 patient, and interrupted aortic arch in 2 patients. Contributory factors included hypoplasia of the aortic arch, anatomical variation of the origin of the vertebral artery, and discrete recoarctation involving the ostium of the subclavian artery. Treatment was by vertebral artery ligation in 3 patients and by prosthetic patch arterioplasty in the patient with recoarctation. The 4 patients remain asymptomatic on follow-up of 16 to 25 months.