Coarctation repair in neonates with subclavian-sparing advancement flap

Subclavian flap aortoplasty and preservation of left upper extremity circulation using an interposition graft

OBJECTIVES

To introduce a surgical technique to maintain left upper limb blood flow after subclavian flap aortoplasty (SFA).

METHODS

Five patients (9 to 23 months of age) with a diagnosis of long-segment aortic coarctation underwent conventional SFA. A Gore-tex graft was interposed between the stump and the proximal descending aorta to maintain perfusion of subclavian artery.

RESULTS

All patients had a patent Gore-tex graft and normal blood flow of the subclavian artery and left upper limb. One patient expired and four others were discharged with a mean follow-up of 48 months. On follow-up all patients had normal development of the left upper limb and no signs of limb ischemia. Echo findings revealed normal arch flow with normal flow in the Gore-tex graft and left upper extremity.

CONCLUSIONS

Interposing a Gore-tex graft between the subclavian artery stump and proximal descending aorta concomitant with SFA can be safely performed in infants with long-segment aortic coarctation, with preservation of left upper extremity circulation.

Upper limb ischemia after subclavian flap aortoplasty: unusual long-term complication

Repair of isolated coarctation of the aorta by subclavian flap aortoplasty carries the disadvantage of impaired blood supply to the left arm. However, ligation of branches of the subclavian artery can be tolerated without manifest ischemia of the upper extremity. We report the case of a young man who suffered from left upper extremity ischemia 18 years after initial operation. Treatment consisted of carotid-subclavian bypass with good outcome. The surgical approach of coarctation by subclavian aortoplasty should be reserved for specific cases, and if this procedure is performed, ligation of branches of the subclavian artery should be minimized to increase inflow into the left brachial artery.