Aortic Coarctation

Umberto G. Rossi; Anna Maria Ierardi; Gianpaolo Carrafiello; Maurizio Cariati

doi:10.1055/s-0040-1701522

AORTA, Table of Contents

CC BY 4.0 · Aorta (Stamford) 2020; 08(02): 046-047
DOI: 10.1055/s-0040-1701522

Images in Aortic Disease

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Aortic Coarctation

Authors

Umberto G. Rossi

¹Department of Diagnostic Imaging, Interventional Radiology Unit, Ente Ospedaliero Galliera Hospital, Genova, Italy

²Department of Diagnostic and Therapeutic Advanced Technology, Diagnostic and Interventional Radiology Unit, Azienda Socio Sanitaria Territoriale Santi Paolo and Carlo Hospital, Milano, Italy
Anna Maria Ierardi

²Department of Diagnostic and Therapeutic Advanced Technology, Diagnostic and Interventional Radiology Unit, Azienda Socio Sanitaria Territoriale Santi Paolo and Carlo Hospital, Milano, Italy
Gianpaolo Carrafiello

³Department of Services and Preventive Medicine, Radiology Unit, Ca' Granda Fondation, Maggiore Policlinic Hospital, University of Milan, Milano, Italy
Maurizio Cariati

²Department of Diagnostic and Therapeutic Advanced Technology, Diagnostic and Interventional Radiology Unit, Azienda Socio Sanitaria Territoriale Santi Paolo and Carlo Hospital, Milano, Italy

Abstract

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Keywords

aorta - coarctation - vascular pathology - computed tomography - imaging - aging

A 45-year-old male was evaluated for arterial hypertension. A pressure gradient (18 mm Hg) between upper and lower limbs was noted. Among the various diagnostic examinations, the patient underwent multidetector computed tomography (MD-CT) angiography. This showed an aortic coarctation at the level of isthmus proximal third of thoracic aorta with significant hypertrophic compensatory collateral arterial circulation ([Fig. 1]). At the time of diagnosis, endovascular or open surgery treatment were offered to the patient, but he refused all intervention. Therefore, the patient was started on life-long antihypertensive medical treatment with clinical and imaging follow-up.

Fig. 1 Multidetector computed tomography angiography sagittal reconstruction demonstrating the presence of aortic coarctation at the level of isthmus proximal third of thoracic aorta (arrowhead) with hypertrophic compensatory collateral arterial circulation from the intercostal and mammary arteries (arrows).

Aortic coarctation in adults is generally recognized via systemic arterial hypertension associated with a pressure gradient between the upper and lower extremities.[1] Precise vascular imaging (MD-CT or magnetic resonance imaging) is mandatory for a complete evaluation of the thoracic aorta, its branches, and possible collateral vessels.[2] [3] Criteria for invasive treatment in adult patients include translesional pressure gradient (>20 mm Hg) and/or evidence of significant collateral vessels.[1] [4] [5] [6] Choice between open surgery versus percutaneous endovascular treatment should be determined by a multidisciplinary team specialists (surgeons, interventional radiologists, and cardiologists).[1] [7] Finally, all patients affected by aortic coarctation require a life-long treatment of arterial pressure and close follow-up (clinical and imaging).

References

References
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Figures

Fig. 1 Multidetector computed tomography angiography sagittal reconstruction demonstrating the presence of aortic coarctation at the level of isthmus proximal third of thoracic aorta (arrowhead) with hypertrophic compensatory collateral arterial circulation from the intercostal and mammary arteries (arrows).