Although aortic coarctation aneurysm has the title of “aneurysm”, it is not really a tumor. However, it is more dangerous than any tumor in terms of rupture and death, and is an “untimely bomb”. The disease has a high mortality rate, is easily misdiagnosed, and its true incidence is often underestimated. Currently, the incidence of aortic coarctation aneurysms is on the rise as the number of people with hypertension increases in China. Aortic coarctation aneurysm is not a tumor growing on the aorta, but an intramural hematoma formed by tearing of the inner lining of the aortic wall caused by various reasons and peeling off between the inner lining and the middle and outer layers due to high pressure arterial blood flow along this level. Aortic coarctation aneurysms mainly occur in middle-aged and elderly people aged 45 to 60 years old, with a male to female ratio of about 3:1. Common causes include hypertension, atherosclerosis, medically induced injury, inflammation, and Marfan’s syndrome. Among them, hypertension and atherosclerosis are the most common causes. Patients with hypertension enter the age of prevalence of entrapment aneurysm 10 to 15 years after the onset of the disease. Another common cause is Marfan’s syndrome, which is a congenital, hereditary disease in which the patient is slender and has an advantage in sports, but often dies of a ruptured aneurysm in youth, also known as the “athlete killer. These are also known as the “athlete killers”. There are several sports stars that we know. Acute aortic coarctation aneurysms are often misdiagnosed and have catastrophic consequences in a relatively short period of time if not diagnosed and intervened early. The rate of misdiagnosis is so high that the true incidence of the disease is difficult to determine because many clinical cases are not diagnosed and the patient has died. In the West, the annual incidence is estimated to be 0.2%-0.8% based on large group autopsies, which is much higher than the number of clinically confirmed cases. Therefore, physicians in all specialties should raise awareness of the diagnosis of this disease. Satisfaction with the diagnosis of myocardial infarction, hypertensive emergencies and acute pulmonary infarction is a common cause of delayed diagnosis of this disease. For example, myocardial ischemia or infarction due to aortic coarct involving the coronary artery opening is indistinguishable from myocardial ischemia and infarction due to primary coronary artery disease, and the principles of treatment for the two are completely different. Aggressive clinical manifestations Pain: The majority of patients present with sudden onset of acute aortic coarctation with severe pain in the precordial region, chest and back, lumbar region or abdomen. The pain often appears when doing certain sudden movements, such as lifting heavy objects, playing ball and abnormal excitement, and can even be induced by yawning, coughing and straining to defecate. If the patient survives the acute phase, the severe pain may gradually disappear or turn into vague pain after a few days. Hypertension: Hypertension is the most common sign in patients with aortic coarctation aneurysms. First, most patients with the disease themselves have an underlying hypertension, and second, the formation of a coarctation aneurysm can in turn further increase the level of blood pressure. Aortic valve insufficiency: Mild insufficiency may be asymptomatic or masked by pain. In moderate or higher aortic valve insufficiency, patients may present with palpitations, shortness of breath, or even coughing up foamy sputum, inability to lie down, and other manifestations of acute left heart failure. Impaired blood supply to organs: Aortic coarctation may involve the opening of the aortic branch vessels, causing impaired blood supply to the corresponding organs. If the coronary artery is involved, angina pectoris and myocardial infarction may occur; if the head and arm trunk is involved, cerebral blood supply disorder, syncope, coma and hemiparesis may occur; if the intercostal artery blood supply disorder is severe, paraplegia may occur; if the abdominal organ blood supply disorder occurs, abdominal pain, abdominal distension, intestinal necrosis, oliguria and renal insufficiency may occur; if the iliac artery is involved, limb pain, weak pulse, no pulse and necrosis may occur. The most serious danger of rupture of a clogged aneurysm is death due to rupture and hemorrhage, and even patients who enter the chronic stage often eventually die due to rupture of a clogged aneurysm, so it is called “untimely bomb” in human body. Rupture of a coarcted aneurysm can produce acute pericardial tamponade and severe blood loss, often resulting in death within minutes. Until the 1950s, the disease was still incurable. Conservative treatments such as blood pressure control, sedation and pain relief were only temporary measures that could not prevent the occurrence of a ruptured coarctation aneurysm. In the late 1950s, with the advent of artificial blood vessels, surgery became the only effective way to prevent rupture of a coarctation aneurysm. 1955 saw the first transthoracic coarctation aortic aneurysm with artificial vessel replacement by American doctors Debakey and Cooley. However, in the early years, the surgical treatment of aortic coarctation was not ideal, with many complications and high mortality. Postoperative neurological complications, acute renal impairment and bleeding have long plagued surgeons. Today, with the clinical application of new artificial blood vessels and sutures, with the continuous improvement of surgical techniques and the improvement of deep cryopause circulation techniques, the surgical efficacy is significantly improved, and the majority of patients can be cured with a significant reduction of complications. In the 1990s, Parodi, an Argentine vascular surgeon, pioneered the minimally invasive treatment of aneurysms – endoluminal isolation – which has gained rapid momentum worldwide. Intraluminal isolation is a minimally invasive procedure that is done only through small incisions and fluoroscopy, which is less invasive and shorter, and brings benefits to the majority of patients. At present, several domestic units have accumulated rich experience. Aortic coarctation aneurysm is divided into type A and type B according to the location of lesion involvement. The former refers to the coarctation involving the ascending aorta and is suitable for surgical treatment; the latter refers to the aortic endothelial rupture located far from the left subclavian artery and the coarctation only involves the descending aorta and is suitable for treatment by endoluminal isolation. Therefore, the choice of treatment method is determined by the lesion site. In our department, we have treated more than 10 cases of aortic coarctation aneurysm this year, with heavy disease and extensive lesions, most of which required total arch replacement and “elephant trunk” surgery, all of which achieved good results without any death or serious complications. The technique of continuous low-flow cerebral perfusion through the axillary artery with deep hypothermic stopping circulation has greatly improved the cerebral protection effect, greatly extended the safety time frame of the operation, and greatly reduced the neurological complications. In addition, we have improved the traditional “elephant trunk” surgery by applying artificial vascular stents, which makes the surgery safer and faster.