Subclavian Steal Syndrome in the Pediatric Age Group

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.