An Unusual Case of Coarctation of the Aorta Repair: A 35-Year Follow-Up

Coarctation of the aorta (CoA) is a congenital narrowing of the thoracic aorta, most often diagnosed in childhood. In adults, surgical repair is less common, with endovascular stenting now preferred when feasible. Open repair, however, remains essential in anatomically complex cases. We describe a male patient who presented in 1988 at age 34, with arterial hypertension and right arm hypoplasia. Imaging revealed severe post-ductal coarctation and an anomalous right subclavian artery arising immediately distal to the narrowed segment. During surgery, trial cross-clamping of the coarctation and aberrant artery resulted in a critical drop in distal pressure, precluding conventional resection and interposition grafting. A bypass repair with a 20 mm Dacron tube graft was performed. The postoperative course was uncomplicated. Thirty-five years later, computed tomography (CT) imaging confirmed the continued competence of the graft. This case illustrates the importance of tailoring CoA repair to individual anatomy. While interposition grafting remains the standard open technique in adults, bypass grafting provides a safe and durable alternative when cross-clamping is not tolerated or anomalous anatomy is present. Long-term follow-up demonstrates excellent durability of bypass grafting, reinforcing its continued role in the surgical armamentarium.