• Images in cardiology

A 49 year old man was referred to our interventionist for percutaneous revascularisation for suspected bilateral renal artery stenosis. Cardiovascular risk factors included smoking, hypercholesterolaemia, and recently diagnosed hypertension. Renal function was normal. Doppler examination of the renal arteries was arranged because of poorly controlled hypertension. Doppler waveform of both renal arteries showed “tardus parvus” pattern (below, R.RA, right renal artery; L.RA, left renal artery) suggestive of significant bilateral renal arteries stenosis.

Physical examination before cardiac catheterisation, however, revealed weak bilateral lower limb pulses, radio-femoral delay and ejection systolic murmur over the back.

Cardiac catheterisation via the femoral approach documented coarctation of aorta with associated 100 mm Hg pressure gradient (right, upper panel). There was associated post-stenotic dilatation. Bilateral renal arteries were normal.

Subsequent magnetic resonance arteriography confirmed a segmental coarctation of the thoracic aorta immediately distal to the takeoff of the left subclavian artery (right, lower panel, arrow points to coarctation). Subsequently, the patient underwent surgical repair and had an uneventful recovery.