Treatment of Coarctation of Aorta in Hypertension

Clinical Scenario

This protocol addresses coarctation of the aorta — including native coarctation and re-coarctation — occurring in patients with concurrent hypertension. Hypertension in this context drives the indication for repair and requires specific management aligned with ESC hypertension guidelines.

Indication

Repair is indicated when hypertension is present alongside an increased non-invasive gradient between the upper and lower limbs, confirmed invasively. The preferred approach to repair depends on anatomical suitability.

Treatment Approach (partial overview)

The repair strategy centres on an endovascular or surgical intervention — with one particular endovascular technique preferred when anatomically feasible. A surgical alternative exists for cases where the endovascular route is less suitable.

Full protocol details, sequencing, and decision criteria available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/eurheartj/ehae179

It is recommended to treat hypertension in patients with coarctation according to ESC hypertension guidelines.
Coarctation or re-coarctation repair (either surgical or endovascular) is indicated in patients with hypertension with an increased non-invasive gradient between the upper and lower limbs (decreased ABI) confirmed with invasive measurement (peak-to-peak >20 mmHg), with a preference for stenting when technically feasible.
In native CoA and re-coarctation covered stenting is the first-choice treatment.
Interposition of a tube graft is the preferred surgical therapy if stenting is less suitable.

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