Carotid Duplex Waveform Analysis of the Left Subclavian Flap Repair

Abstract

Extracranial carotid duplex ultrasound is a fast and effective way to study the patency of the extracranial system in most cases. The evaluation of the waveforms of the carotid system can provide valuable clinical information. In this case study, antegrade flow in the left vertebral artery in the absence or occlusion of the left subclavian artery reveals that this is not a subclavian steal case. The normal bi- to triphasic waveform in the left brachial artery, reconstituted with collateral in the thoracic region, supports this argument. The triphasic waveform in the bilateral internal carotid and vertebral arteries correlates with a severe case of congestive heart failure. This case study is a rarely reported extracranial carotid system of a patient status after subclavian flap repair for aortic coarctation in which a portion, if not all, of the subclavian artery has been used as a flap to expand the area of narrowing of the aorta.