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 man ifest ischemia of the upper extremity. We report the case of a young man wh o suffered from left upper extremity ischemia 18 years after initial operat ion. Treatment consisted of carotid-subclavian bypass with good outcome. Th e surgical approach of coarctation by subclavian aortoplasty should be rese rved for specific cases, and if this procedure is performed, ligation of br anches of the subclavian artery should be minimized to increase inflow into the left brachial artery. (C) 2000 by The Society of Thoracic Surgeons.