Subclavian steal phenomenon demonstrated by ultrasound in a dog with hypoplastic aberrant left subclavian artery

Barge, P.; Vincenti, S.; Geissbühler, U. (2021). Subclavian steal phenomenon demonstrated by ultrasound in a dog with hypoplastic aberrant left subclavian artery. Journal of small animal practice, 62(11), p. 1034. Wiley 10.1111/jsap.13383

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A 20-month-old male neutered mixed breed dog was referred for recent onset of cough, apathy, recurrent regurgitations since adoption and segmental megaoesophagus, diagnosed on radiog-raphy. General condition, physical examination, haematology and biochemistry were normal. Thoracic CT angiography was performed under general anaesthesia. The right subclavian artery was independent from the brachiocephalic trunk. There was dex-traposition of the aorta and cranial thoracic oesophageal dilation associated with focal narrowing of its lumen at the site where a non-enhancing hypoattenuating area was identified, between the most cranial aspect of the descending aorta and the pulmonary trunk. The origin of the left subclavian artery from the aortic arch was not visible. Its cranial aspect was markedly narrowed before joining the left vertebral and axillary arteries (Fig 1A). A diagnosis of a persistent right aortic arch (PRAA) and a hypoplastic aber-rant left subclavian artery with cranial oesophageal dilation was made. A non-patent ligamentum arteriosum was also suspected. A right sided first intercostal focused ultrasound was performed in an attempt to assess the flow of the vertebral artery. Retrograde (i.e. dorsoventral direction) flow of the left vertebral artery was demonstrated (Fig 1C). A left lateral thoracotomy confirmed a type 3 vascular ring anomaly and failed to visualise the hypoplastic aberrant left subclavian artery. The ductus arteriosum was ligated. Recovery was uneventful and discharge was performed three days following surgery. One month follow up showed complete resolu-tion of the clinical signs. Subclavian steal phenomenon describes a retrograde blood flow of the vertebral artery due to an ipsilateral subclavian artery stenosis. As in this case, a significant proportion of the arterial supply to the left forelimb was provided by the left ver-tebral artery rather than through the hypoplastic subclavian artery.

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