Transcatheter intervention for doublesteal syndrome from isolation of the subclavian artery associated with patent ductus arteriosus

Isolation of the subclavian artery is a rare aortic arch anomaly, in which the left subclavian artery (LSCA) does not originate from the aortic arch and is connected to the pulmonary artery, through the arterial duct. A five-year-old girl, with left-arm claudication symptoms and a diagnosis of patent ductus arteriosus (PDA), was referred for interventional PDA closure. Blood pressure measurement showed that her right-arm systolic pressure was 30 mm Hg higher than that of her left arm. An unusual PDA was detected on echocardiography. During catheter angiography, a right-sided aortic arch was observed, and injection into the right vertebral artery (RVA) demonstrated a retrograde flow, down the left vertebral artery (LVA) to the LSCA, PDA, and pulmonary artery (Videos 1 and 2). The patient had a pathology resulting in double-steal syndrome, from the LVA to the left arm and the pulmonary artery. PDA closure was planned to eliminate the pulmonary artery steal. However, passing the PDA through the antegrade route was not possible. The PDA was closed with an Amplatzer duct occluder type II device, via the retrograde route (Videos 3–7). After 1 month, pain in the left arm was decreased. When coarctation is not detected in a patient with PDA, an isolated LSCA should be considered, particularly when the left upper extremity blood pressure is low. Due to subclavian steal syndrome, the PDA closure using the transcatheter intervention and disconnecting the subclavian artery from the pulmonary artery represents a safe therapeutic alternative to surgery in patients without critical extremity ischemia.