Subclavian-to-descending aortic bypass for the treatment of severe late-stage aortic coarctation in a 62-year-old adult: a case report and literature review

TL;DR

A 62-year-old man with severe aortic coarctation underwent successful subclavian-to-aorta bypass surgery, highlighting the importance of early diagnosis and tailored treatment in adults.

Contribution

This case report presents a rare adult instance of severe aortic coarctation and its successful surgical management.

Findings

Subclavian-to-descending aortic bypass normalized blood pressure and resolved symptoms in a 62-year-old with severe CoA.

Postoperative follow-up showed patent graft flow and sustained improvement at six months.

The case emphasizes the need for individualized surgical strategies in atypical adult presentations of CoA.

Abstract

Aortic coarctation (CoA) is a congenital cardiovascular condition usually diagnosed in infancy or childhood. Cases in adults are rare and often go undetected because symptoms can be obscured by extensive collateral circulation.

A 62-year-old male was admitted to Gansu Provincial Hospital in December 2024 with complaints of recurrent chest tightness, shortness of breath, blurred vision, and tinnitus persisting for over two months. Physical examination revealed significant blood pressure discrepancies between the upper and lower extremities (>50 mmHg). Imaging confirmed severe CoA with nearly complete interruption of the descending aorta, extensive collateral circulation, and complications, including hypertensive crisis with cerebral hemorrhage likely due to extreme hypertension, and bronchiectasis with active pulmonary infection. After multidisciplinary team evaluation, left subclavian artery-to-descending aorta bypass grafting was performed. Postoperatively, blood pressure normalized across all limbs, and the patient remained asymptomatic at the six-month follow-up, with patent graft flow.

This case of severe CoA in a 62-year-old male highlights the importance of early recognition of atypical presentations in adult patients, the need for individualized surgical strategies, and the benefits of long-term follow-up to ensure successful management and optimal outcomes.

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