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\begin{document}

\title{Coarctation of Aorta Combined with Multiple Aneurysms}



\author[1]{Yongjun Qian}%
\author[1]{Tiange Li}%
\author[1]{He Siyu}%
\author[1]{Yunfei Ling}%
\affil[1]{Sichuan University West China Hospital}%


\vspace{-1em}



  
  \date{June 18, 2024}


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\selectlanguage{english}
\begin{abstract}
We reported a case of a 53-year-old patient with coarctation of aorta
and multiple aneurysmatic changes on aortic arch. Enhanced CT and
reconstruction revealed significant coarctation and multiple
aneurysmatic dilatation. The patient underwent stent implantation and
was discharged with symptoms relived. Follow-up examination progression
of aneurysms, however, without symptoms.%
\end{abstract}%



\sloppy


\textbf{Title Page}

\textbf{Coarctation of Aorta Combined with Multiple Aneurysms}

Tiange Li \textsuperscript{1}; Siyu He\textsuperscript{1}; Yunfei
Ling\textsuperscript{1}; Yongjun Qian\textsuperscript{1\#}

\textsuperscript{1} Department of Cardiovascular Surgery, West China
Hospital, Sichuan University, No. 37 GuoXue Xiang, Chengdu, Sichuan,
610041, People's Republic of China.

\textsuperscript{\#} Address for correspondence: Yongjun Qian

Email:\emph{qianyongjun@scu.edu.cn}

Tel: + 86 028 85422897

Fax: + 86 028 85421833

\textbf{Conflict of interests}

All authors declared that there was no conflict of interests.

\textbf{Ethics statement}

This manuscript and all of its content meet the ethical guidelines,
including adherence to the legal requirements of the study country. The
need for patient consent was waived.

\textbf{Informed consent}

Written informed consent was obtained from the patient and patient's
family for publication of this case report and any accompanying images.

\textbf{Funding}

This article was funded by 1\selectlanguage{ngerman}·3·5 project for disciplines of
excellence--Clinical Research Incubation Project, West China Hospital,
Sichuan University (No. 2019HXFH029 and No. ZYJC21064)

\textbf{Author contributions}

Tiange Li and Siyu He prepared this manuscript. Tiange Li was
responsible for images and figures in this paper. Yunfei Ling and
Yongjun Qian completed surgical procedure. Yongjun Qian checked and
revised the manuscript.

\textbf{Coarctation of Aorta Combined with Multiple Aneurysms}

\textbf{Abstract}

We reported a case of a 53-year-old patient with coarctation of aorta
and multiple aneurysmatic changes on aortic arch. Enhanced CT and
reconstruction revealed significant coarctation and multiple
aneurysmatic dilatation. The patient underwent stent implantation and
was discharged with symptoms relived. Follow-up examination progression
of aneurysms, however, without symptoms.

A 53-year-old woman presented to the department of cardiovascular
surgery with palpitation and dyspnea for one month. A 4-year history of
recurrent dizziness was found through interrogation. Blood pressure of
her limbs showed significant differences, her left upper limb blood
pressure, similar as both lower limbs, were obviously lower than in
normal, while blood pressure of right upper limb was about 155/85 mmHg,
which was higher than in normal.

Vertical plane image of enhanced-contrast CT demonstrated coarctation of
descending aorta and several aneurysmatic dilatation (Figure 1).
Three\selectlanguage{english}-dimensional reconstruction of the computed tomography imaging
showed multiple aneurysmatic dilatation on both the proximal of the left
subclavian artery and the aortic arch. The diameter of the largest
saccular aneurysm was 2.6cm, and a small aneurysmal sac was at the back
side (Figure 2, \emph{panel A\textasciitilde{}C} ).

In patients with coarctation of aorta, the blood pressure of the lower
extremities is relatively lower than the upper extremities. The patient
had a pressure difference greater than 20 mm Hg between the upper
extremities{[}1{]}, indicating a combination of a left subclavian artery
aneurysm. Coarctation of aorta combined with subclavian artery aneurysm
was found in about 2\% of patients{[}2{]}, and the formation of
aneurysmatic changes may due to the hemodynamic effect of the narrowing
aorta. In this case, a stent was inserted to dilatate the coarctation
and the patient was discharged uneventfully. The re-examination was
carried out 7 years later, though patient remained asymptomatic,
reconstruction demonstrated a larger aneurysm of aortic arch with the
diameter of 4.6cm, while the left subclavian artery aneurysm remained
the same (Figure 2, \emph{panel D\textasciitilde{}F} ).

\textbf{References}

1. Arikan, A.A., et al., \emph{Coarctation of the aorta with aortic and
subclavian artery aneurysms.} J Card Surg, 2021. \textbf{36} (6): p.
2171-2174.

2. Vierhout, B.P., et al., \emph{Changing profiles of diagnostic and
treatment options in subclavian artery aneurysms.} Eur J Vasc Endovasc
Surg, 2010. \textbf{40} (1): p. 27-34.

\textbf{Figure legend}

\textbf{Figure 1} Enhanced-contrast CT revealed coarctation of
descending aorta (black arrow) combined with the several aneurysmatic
dilatation (black star).

\textbf{Figure 2} A, Enhanced-contrast CT revealed the multiple
aneurysms of the aortic arch (black star). B\&C, Three-dimensional
reconstruction demonstrated significant dilated subclavian artery (white
arrow), a small saccular aneurysm (red arrow) and the aneurysmatic
dilatation of the aortic arch (black star). D\textasciitilde{}F, Images
of re-examination 7 years later in the same perspective.\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Fig-1/Fig-1}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Fig-2/Fig-2}

\end{center}
\end{figure}

\selectlanguage{english}
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