Mohammad Younes, Ali Deeb
A 5-month-old infant with critical juxtaductal coarctation (CoA) and an aberrant right subclavian artery (ARSA) underwent successful single-stage repair. Preoperative computed tomography angiography (CTA) confirmed the ARSA originating distal to the coarctation shelf, a critical finding for surgical planning. Through a left thoracotomy, the ARSA was ligated and divided to prevent vascular steal and allow tension-free mobilization. After confirming adequate collateral perfusion to the right arm, an extended end-to-end anastomosis was performed to resect the coarctation. The postoperative course was uncomplicated, with no residual gradient or limb ischemia. This case underscores the importance of preoperative CTA for detecting arch anomalies like ARSA in CoA patients. A tailored approach with initial ARSA division facilitates a successful extended end-to-end repair, ensuring excellent hemodynamic outcomes and preserving upper limb viability.