Hypertension Secondary to Severe Aortic Coarctation in an Adult Patient

A 42-year-old man with a 24-year history of poorly controlled hypertension was admitted following a traumatic femoral fracture. Cardiovascular evaluation was prompted by a 25 mmHg systolic blood pressure difference between the left upper limb (165/90 mmHg) and the left lower limb (140/85 mmHg), along with an interscapular systolic murmur, during trauma admission, suggesting coarctation. Chest X-ray revealed rib notching and the classic "3-sign," raising suspicion of aortic coarctation. Transthoracic echocardiography (TTE) showed no intracardiac deformity and demonstrated a peak-to-peak gradient of 60 mmHg across the aortic isthmus. CT angiography (CTA) confirmed a severe coarctation, with a minimal luminal diameter of 3 mm, located 38 mm distal to the left subclavian artery, and extensive collateral circulation via intercostal and internal mammary arteries. A staged endovascular approach was undertaken due to complex anatomy, with successful deployment of two BeGraft covered stents (24×48 mm and 22×48 mm). Despite anatomical correction, the patient remained hypertensive, was discharged 10 days later without symptoms, and was enrolled in regular follow-up for blood pressure control.