Abdominal aortic coarctation in a middle aged adult

Abstract

A 53-year-old male was being evaluated for endocarditis and mitral valve prolapse. Computed tomography angiography of the thorax and abdomen demonstrated a complete aortic coarctation with a rich network of collateral vessels, arising from the lumbar and inferior mesenteric arteries (Cover and A; see Video, online only). Abdominal aortic coarctation is an uncommon pathology. Fusion of the dorsal embryonic aortas and viral-mediated diseases such as rubella have been identified as possible causes. Most patients present by their early twenties for uncontrollable hypertension, which, if left untreated, results in death at a mean age of 34 years.1Stanley J.C. Criado E. Eliason J.L. Upchurch Jr., G.R. Berguer R. Rectenwald J.E. Abdominal aortic coarctation: surgical treatment of 53 patients with a thoracoabdominal bypass, patch aortoplasty, or interposition aortoaortic graft.J Vasc Surg. 2008; 48: 1073-1082Abstract Full Text Full Text PDF PubMed Scopus (86) Google Scholar, 2Connolly J.E. Wilson S.E. Lawrence P.L. Fujitani R.M. Middle aortic syndrome: distal thoracic and abdominal coarctation, a disorder with multiple etiologies.J Am Coll Surg. 2002; 194: 774-781Abstract Full Text Full Text PDF PubMed Scopus (134) Google Scholar, 3Hallett Jr., J.W. Brewster D.C. Darling R.C. O'Hara P.J. Coarctation of the abdominal aorta: current options in surgical management.Ann Surg. 1980; 191: 430-437Crossref PubMed Scopus (81) Google Scholar Interestingly, our patient was completely asymptomatic. He never had hypertension nor claudication even while regularly playing soccer in an amateur league until the age of 30 years. This physical athletic activity most likely both led to the development of the extensive network of pelvic collaterals and accounted for his lack of claudication symptoms (B and C; see Video, online only). Consent was obtained from the patient for the publication of this report. Download .doc (1.37 MB) Help with doc files CovereyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiJjYzNmZWE5NGZhMjY3OWZlY2ViZTA4MGUyZjAyNjU0OSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc3OTkwNzI2fQ.TFS7Zl1GotOHCXBORH_2oO5O7c99YFXg5VOfAtROsvp5lUBELaCv4DvYH0WPJgb68NxQZSiDMwAlpGqBGiuynUCJ9MXv3HVquj9eC51LjU8BxJZ-4-KiLE-zmZPUGUrPeuFNHc69D2buTDW3I_zVeSQFZUvuLaVLfIp4kmclk13oQBWr5VemhMBeFe5iTS1DDEo42vISGzwg8V8k5Xj-pnMi-G_45xzu8erYL1VO1gySZwmfBEeU6XDfH1bqL5NMv3CTAOuqa05TjHHzYPyaYYdNYm0ZBxUu1VpiHP8XLrcnG37fqGiC5F1DRHf-oJCAy4lK7Il_2YwvBS8w-4M7eA Download .mp4 (6.46 MB) Help with .mp4 files Video, online onlyComputed tomography angiography scan of the patient, transverse view.eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiIxOTA5MzIxNWFjYmFhZTUzNDczYjQxMTg2OWQwMWZmZiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc3OTkwNzI2fQ.qoKKzYvtekTNhUUZTjhIwyEG_PNbbn6ircc2m9EZft--txuJIzVTbejnWPeFfjonSiMbWuro0FpLqdm5NYxMy0bo_2lk05HrGYJspUKqOVRdlhlMOFAubnyZW1jwioEi0iQz1jLbkNEkU8bmUy_EOEnSL73Py1N0TdlbTh1kRjj7nmPl3F4pUteqnMbwuC3ux9LO2hx0gW-46CIJ7yV48lUhpEb7nlpTEM3igmFkdWPFdr2m2cx4RVqFUlJHHt8ATta16WZbV3-Z4Iyd3Y86rDAwHm4b8TlwRTNOfH1h_vdf6p9RO-3izNe97RIeKY4S39Y7w5vHXhnTcdpgMP-cdQ Download .mp4 (6.38 MB) Help with .mp4 files Video