[Subclavian-aortic Bypass for Management of Aortic Coarctation in Adults:Report of a Case].

A 57-year-old man presented to the hospital with dyspnea. A diagnosis of hypertensive heart failure was made, and treatment was initiated. However, his ankle-brachial index had decreased to 0.61 on the right and 0.56 on the left side, and he had intermittent claudication with decreased renal function( serum creatinine, 1.73 mg/dl). Thoracoabdominal contrast-enhanced computed tomography showed severe stenosis with a diameter of 2.2 mm in the distal arch and marked development of collateral vessels, and a diagnosis of aortic stenosis was made. Vascular catheterization revealed a pressure gradient of 60 mmHg between the upper and lower extremities. We performed a left-sided open thoracotomy and left subclavian-descending aortic bypass( 16 mm J Graft, Shield). The patient recovered without postoperative complications, and the pressure gradient between the upper and lower extremities eventually decreased to 6 mmHg.