Endovascular treatment of a rare cause of secondary hypertension in an elderly woman

Abstract

A 70-year-old woman on four antihypertensive drugs including diuretics presented with accelerated hypertension and acute pulmonary oedema. She had a bounding brachial pulse with feeble femoral pulses. A 256 slice CT scan revealed the presence of severe diffuse thoracoabdominal atherosclerosis. Cardiac catheterisation revealed 125 mm Hg gradient across the atherosclerotic segment at the level of thoracic 10-11 vertebrae. A self-deploying stent was implanted in the thoracoabdominal segment reducing the gradient across the disease segment to 20 mm Hg with a significant improvement in the luminal diameter of the aorta. Her upper limb blood pressure normalised on two antihypertensive drugs 6 weeks later.

Figure 1

Aortic angiogram showing diffuse narrowing of the thoracoabdominal aorta along with a discrete calcific lesion at the level of thoracic vertebrae 10–11.

Figure 2

Aortic pressure tracing shows a gradient of 125 mm Hg across the prestenotic and poststenotic segment of the thoracic aorta.