Pathophysiology
- Aorta narrowed below origin of left subclavian artery and therefore blood flow to abdomen and legs is reduced
- Prominent vessels over the back and large collaterals that have developed to bypass the obstruction supply the legs
- Collaterals form between branches of the subclavian artery, especially internal mammary and scapular vessels
Approach
- Expose back
- Inspection
- Large prominent tortuous blood vessels runing over the left scapula
- Palpation
- Demonstrate they are arteries
- Percussion
- Auscultation
- Systolic bruits
Completion
- Examine pulses of arms and legs (upper limb stronger than lower limb)
- Patient usually hypertensive
- Radio-femoral delay
- Examine praecordium for ejection systolic murmur
Investigations
- CXR: notching on the underside of ribs (erosion from intercostal vessels)
- Barium swallow
- Echocardiogram
- CT / MRI
Associations of coarctation
- Bicuspid aortic valves
- Aortic stenosis
- Aneurysms of circle of Willis
Treatment options
- Non-surgical
- Investigation and treatment of abnormalities
- Management of hypertension
- Surgical
- End-to-end anastamoses, patching and use of left subclavian artery as a flap