A rare case of abdominal aortic coarctation in a pediatric patient

Abdominal aortic coarctation (AAC) is a rare cause of renovascular hypertension in pediatric patients, particularly when linked to vasculitis. It presents unique diagnostic and therapeutic challenges. It is often associated with severe hypertension and lower limb ischemia. This case underscores the crucial role of timely surgical intervention in complex vascular cases.

We report a pediatric patient with severe hypertension and diminished renal function. Imaging revealed segmental abdominal aortic narrowing with left renal artery stenosis. Medical management and attempted angioplasty failed. Aortic bypass grafting was performed, along with left nephrectomy due to irreversible ischemic damage. The patient showed marked postoperative improvement in blood pressure and end-organ perfusion.

AAC with an inflammatory component often resists conservative and endovascular therapies due to the development of fibrotic changes in the vessel wall. Surgical revascularization provides durable outcomes and improved control of hypertension. Identification of vasculitis necessitates long-term immunologic monitoring and treatment.

Surgical bypass is the preferred intervention in pediatric AAC refractory to medical and endovascular management, primarily when associated with vasculitis. Early multidisciplinary involvement is essential to prevent permanent organ damage and optimize outcomes.