Explain Subclavian Flap Aortoplasty ?

Initial steps are same as for resection and end-to-end anastomosis. After exposing a the entire length of intra thoracic segment of left subclavian artery, it is ligated just proximal to the point of exit from the chest. A clamp is applied on the aortic arch proximal to left subclavian artery. Another clamp is applied on the descending aorta distal to the narrow segment of the descending aorta. Intercostal vessels that need not be divided are looped for temporary control. The transacted subclavian artery is incised vertically. Same incision is continued across the coarcted segment on to the descending aorta well below the narrow segment. The intimal shelf of coarctation is excised. The subclavian flap is turned down and anastornosed starting at the apex of the incision on the descending aorta with double armed 6-0 absorbable sutures. Same suture is continued upwards posteriorly and then anteriorly. Distal clamp is removed first and then proxitnal clamp.

Figure: Subclavian flap aortoplasty

After any coarctation repair, pressures are measured proximally and distally. There should not be a gradient of more that 10 mm of Hg.