Aortic Isthmus Stenosis (ISTA), Coarctation of the Aortic Isthmus


Narrowing of the aorta between the origin of the left subclavian artery and the junction with the ductus and the descending aor


Access is via a left posterolateral thoracotomy. The left lung, the aortic arch, the brachiocephalic trunk, the carotid artery and the left subclavian artery are displaced so that the ductus and the descending aorta can be mobilized together with the first pair of intercostal arteries. The ductus is divided and the aortic isthmus resected. Then the aortic arch distal to the origin of the brachiocephalic trunk, the cartotid artery, the left subclavian artery and the descending aorta are clamped and incised. To enlarge the aortic arch and anastomose it to the descending aorta there are several possibilities:

  • extended end-to-end anastomosis (method favored by the DHZB)
  • anastomosis with patch (Vosschulte method)
  • anastomosis with a subclavian artery flap (Walthausen method)