Iliac Artery Dissection After Stenting Preductal Coarctation of the Aorta Associated With Severe Pulmonary Artery Hypertension

Document Type : Case Report


1 Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

2 Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

3 Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.


Preductal coarctation of the aorta associated with patent ductus arteriosus (PDA) during adulthood is very rare. We herein describe a 19-year-old female patient with this anomaly who presented with ascites and dyspnea (functional class III). A complete evaluation showed a large PDA, a large ventricular septal defect, severe coarctation of the aorta, severe pulmonary arterial hypertension, and severe biventricular dysfunction. Cardiac catheterization revealed evidence of a left-to-right shunt via the ventricular septal defect and vasoreactivity in the pulmonary artery. Staged interventions were, therefore, planned. The PDA was closed, and the coarctation was relieved with a Covered CP Stent. On the first postprocedural day, the patient complained of leg pain. Physical examination showed that she was pulseless. Once again, she was transferred to the catheterization laboratory, where dissection and thrombosis were detected in the iliac and femoral arteries. Balloon angioplasty and stenting of the iliac artery to the femoral artery were performed successfully. During the follow-up, the lower limb pulses were normal, biventricular function was improved, and pulmonary artery pressure was decreased significantly. (Iranian Heart Journal 2021; 22(2): 130-135)


  1. Geggel RL, Hijazi ZM, Rhodes J. Interventional cardiac catheterization therapy for combined coarctation of the aorta and patent ductus arteriosus: successful outcome in two infants. Cathet Cardiovasc Diagn. 1996; 38:67–70.
  2. Yilmaz EH, Bulut MO, Küçük M, Yücel IK, Erdem A, Çelebi A. Use of covered stents in simultaneous management of coarctation of the aorta and patent ductus arteriosus. Anatol J Cardiol. 2018; 19:232-236. DOI:10.14744/AnatolJCardiol.2018.61257
  3. Firoozi A, Mohebbi B, Noohi F, Bassiri H, Mohebbi A, Abdi S, Maleki M, Shafe O, Peighambari MM, Alemzadeh-Ansari MJ, Bakhshandeh H, Rezaei Y, Sepehrvand N. Self-Expanding Versus Balloon-Expandable Stents in Patients with Isthmic Coarctation of the Aorta. Am J Cardiol. 2018; 122(6):1062‐1067. doi:10.1016/j.amjcard.2018.06.005
  4. Khajali Z, Sanati HR, Pouraliakbar H, Mohebbi B, Aeinfar K, Zolfaghari R. Self-expandable stent for repairing coarctation of the left-circumferential aortic arch with right-sided descending aorta and aberrant right subclavian artery with Kommerell's. Annals of vascular surgery 38, 318. e7-318. e10. doi: 10.1016/j.avsg.2016.05.116.
  5. Hakim F, Hawelleh AA, Goussous Y, Hijazi ZM. Simultaneous stent implantation for coarctation of the aorta and closure of patent ductus arteriosus using the Amplatzer duct occluder. Cathet Cardiovasc Interv. 1999; 47:36–8.
  6. Khajali Z, Ali Basiri H, Maleki M. Persistent fifth aortic arch associated with coarctation of aorta: a case report. Congenit Heart Dis 2011; 6:650e2. DOI:10.1111/j.1747-0803.2011.00492.x
  7. Scheinert D, Ludwig J, Steinkamp HJ, Schröder M, Balzer JO, Biamino G. Treatment of catheter-induced iliac artery injuries with self-expanding endografts. J Endovasc Ther. 2000; 7(3):213‐220. doi:10.1177/152660280000700308
  8. Khajali Z, Maleki M, Mohebbi B, Aliramezany M. Coarctation Stenting in a Rare Case with Con­genitally Corrected Transposition of the Great Arteries and the Bicuspid Aortic Valve. J Teh Univ Heart Ctr 2020; 15(1):27-30.
  9. Kulkarni S, Vimala J, Parmar R. Single therapeutic catheterization for treatment of native coarctation of aorta and large patent ductus arteriosus using a covered stent. Indian Heart J. 2005; 57:713–6.
  10. Firouzi A, Mohebbi B, Shafiei A. Endovascular Repair of Interrupted Aortic Arch: Approach with Hope for Fewer Complications. Arch Iran Med. 2017; 20(12):756‐759.