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A 57 year old woman, who had suffered from hypertension for 37 years, consulted our hospital because of palpitations, headache, dyspnoea, and paraesthesia in both legs. Physical examination revealed that her blood pressure was 186/86 mm Hg in both arms and 128/94 mm Hg in both legs. Auscultation revealed an aortic systolic murmur with radiation to the epigastrium. Serological examination revealed no abnormality.
Computed tomographic scanning revealed diffuse narrowing with severe calcification at the diaphragmatic level of the descending aorta (left). Digital subtraction angiography confirmed the narrowing of the thoraco-abdominal aorta (below). A gradient of 87 mm Hg was measured across the narrowed segment of the abdominal aorta. There was no stenosis in coronary, carotid, renal, axillary, iliac, and pulmonary arteries. Because the stenotic lesion was diffuse with severe calcification, surgery was recommended instead of balloon dilatation. A left axillary–left iliac artery bypass was performed. After the operation, there was no difference in blood pressure between the upper and lower limbs. The patient recovered uneventfully and has no residual hypertension.
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