Extra-anatomic bypass can treat renovascular hypertension due to atherosclerotic atypical aortic coarctation

Atypical aortic coarctation causing high-grade descending thoracic aortic stenosis secondary to calcified atherosclerosis is rare. We have described the case of a 75-year old man with uncontrolled renovascular hypertension secondary to this etiology. His unique anatomy meant he was not a candidate for endovascular management and his multiple comorbidities meant he was high risk for open thoracoabdominal surgery. He successfully underwent extra-anatomic bypass. Postoperatively, his renovascular hypertension improved, and he was weaned off multiple intravenous and oral antihypertensive medications. The findings from the present case suggest that extra-anatomic bypass can be a good option for treating selected patients with renovascular hypertension due to atypical aortic coarctation.