Symptomatic Subclavian Steal During Pregnancy in a Woman Status Post Coarctation Repair in Infancy

Abstract

<jats:p> A 24-year-old woman with a history of coarctation repair by subclavian flap aortoplasty presented at 15 weeks’ gestation with transient episodes of vision loss. She was diagnosed with subclavian steal syndrome and underwent left carotid artery to subclavian artery bypass at 17 weeks’ gestation. She has had no recurrence of symptoms at ten months of postoperative follow-up. Despite the anatomic substrate for subclavian steal in patients with this type of surgical repair, neurologic symptoms are uncommon. It is possible that the pregnancy-induced fall in systemic vascular resistance triggered symptoms in this previously asymptomatic patient. </jats:p>

Vertebrobasilar insufficiency after subclavian flap aortoplasty for aortic coarctation

“…However, when it does occur, it seems to occur in a delayed fashion during adulthood. 10 , 11 It is unclear why patients might be asymptomatic for >1 decade before developing neurologic symptoms.…”

“…Subclavian aortoplasty was performed often in the 1970s and 1980s but is now rarely performed due to recurrent coarctation rates of ≤42% and significant risks of limb ischemia, limb dysfunction, subclavian steal syndrome, and aneurysmal degeneration. 2 , 3 , 7 , 10 , 12 The incidence of these complications after subclavian flap aortoplasty is not well defined.…”

“…Due to the poorly defined complication rates, modifications to subclavian flap repair are made on a case-by-case basis, because no consensus has been reached regarding ligation of the vertebral artery or revascularization of the subclavian artery. 3 , 7 , 10 Today, most coarctation repairs are performed with an extended end-to-end anastomosis, with ≤5% performed with subclavian flap aortoplasty. 1 There are several known complications that can occur in a delayed fashion, ≤25 years or more after surgery for aortic coarctation.…”

“… 9 Additionally, there have been reports of delayed presentation with subclavian steal syndrome ≤24 years after treatment. 10 , 11 Thus, in some cases of subclavian aortoplasty, the left vertebral artery is ligated. 7 , 10 We present the case of a patient who developed symptoms of subclavian steal syndrome 36 years after subclavian aortoplasty without vertebral artery ligation.…”

“… 10 , 11 Thus, in some cases of subclavian aortoplasty, the left vertebral artery is ligated. 7 , 10 We present the case of a patient who developed symptoms of subclavian steal syndrome 36 years after subclavian aortoplasty without vertebral artery ligation. The patient provided written informed consent for the report of her case details and imaging studies.…”