CONGENITAL SUBCLAVIAN STEAL

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Abstract
Five cases of congenital subclavian steal demonstrated by angiography are reported. The anatomy, hemodynamics, clinical findings and angiographic features are reviewed. Ischemic symptoms are infrequently present in infants and children and most cases are discovered incidentally during evaluation of congenital heart disease and/or coarctation of the aorta. The relative lack of symptoms in infants and children when compared to adults reflects in part more collateral development and the absence of associated occlusive disease of the cerebral vessels in children. While the natural history of this disorder is not known, there is some evidence that cerebral ischemic symptoms may arise as early as the fourth decade. Subclavian steal associated with a right aortic arch usually occurs on the left side and is caused by hypoplasia, atresia or isolation of the proximal portion of the left subclavian artery. Subclavian steal associated with a left aortic arch is usually caused by coarctation of interruption of the aortic arch with the affected subclavian artery arising distal to the obstruction. Arch aortography is the best method to evaluate possible congenital subclavian steal.

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