A 20-year-old man was referred to our outpatient clinic for evaluation of arterial hypertension and claudicatio intermittant complaints. In physical examination, the arterial blood pressure was 190/90 mmHg in both arms. Although the pulses were equal over both upper extremities significant radial-femoral delay was noted. The bilateral femoral and popliteal pulses were found to be nonpalpable; 2/6 midsystolic murmur was heard on the left scapular region in the back. High voltage were encountered on the resting ECG. Transthoracic echocardiography showed concentric left ventricular hypertrophy accompanied in spite of the fact that there was found no significant pressure gradient distal to aortic isthmus in doppler analysis. At subsequently performed cardiac catheterisation via right brachial and femoral arteries, a complete aortic arch interruption distal to the subclavian artery take-off was imaged using a simultaneous approach from the right brachial artery and femoral artery ( Figure 1A). The peak systolic pressure above the interrupted segment was 190 mmHg, and the pressure below it was 100 mmHg. Then, the occlusion was perforated retrogradely from descendin aorta by way of the right femoral artery using coronary chronic total occlusion guidewire (Hi-torque Pilot 200 190 cm, Abbott Vascular, USA) that was snared with a Amplatz Goose neck snare (eV3 company, USA) from the right brachial artery. Over an brachio-femoral arterial loop performed using an a 0.014” coronary guidewire, the stenosis was consecutively dilated with coronary (1.5.0X20 mm, 3.5X20 mm; brio balloon, CID Company, Italy) and peripheral angioplasty balloons (6.0X20 mmViatrac 14 Plus; Abbott Vascular, USA). Then, a 12 F delivery sheath crossed the dilated segment of the aorta; subsequently, a 28 mm long covered Cheatham Platinum (CP) stent (NuMED Inc, New York, USA) was successfully relieved by progressively dilated to 24 mm (Figure 1B). Post-procedure peak pressure gradient was 5 mm Hg. After 3 months, control echocardiography showed 30 mmHg maximal gradient. Control angiography demontrated a maximal gradient of 32 mmHg. We performed second aortic balloon angioplasty into the stent; subsequently, maksimal gradient decreased to 5 mmHg (Figure 1C).
