The normal human arterial vasculature consists of 3 layers of structures, the intima, the mesima and the epima, and the 3 layers fit closely together to carry the blood flow through. Arterial entrapment, on the other hand, is the gradual peeling and expansion of the intima due to a localized tear in the intima, which is subjected to a strong blood shock, creating two lumens, a true and a false, within the artery. This leads to a number of manifestations including tear-like pain. Depending on the site of the rupture and the location of the artery, the entrapment can involve various parts of the body. The most common and most dangerous is aortic entrapment, while others include superior mesenteric artery entrapment, carotid artery entrapment, etc. The manifestations vary depending on the site of blood supply. This article focuses on aortic coarctation. Causes Aortic coarctation is one of the most common aortic diseases in which blood enters the aortic wall through a fissure in the intima and causes separation of the normal arterial wall. So what kind of people are prone to aortic coarctation? That is, what is the cause or causes of aortic coarctation? Aortic coarctation is the result of the interaction of abnormal mid-membrane structure and abnormal hemodynamics of the aorta. When the aortic structure is abnormal is naturally prone to aortic dissection, common factors include: Marfan syndrome, congenital cardiovascular malformations, idiopathic aortic mesenteric degenerative changes, aortic atherosclerosis, aortic inflammatory disease, etc. We know the American female volleyball player Hyman and the male volleyball player Zhu Gang as these reasons, and collapsed on the sports field. Arterial wall damage is also easily caused when hemodynamics are altered. The most common cause is hypertension, and almost all patients with aortic coarctation have poorly controlled hypertension. In other words, the control of hypertension has a comprehensive impact on the prevention, treatment, and prognosis of aortic coarctation, and is the most basic and least negligible means of treatment and prevention. Pregnancy is another high incidence factor, associated with altered hemodynamics during pregnancy. Among women who develop the disease before the age of 40, 50% occur during pregnancy. The ratio of male to female incidence of aortic coarctation is 2 to 5:1; the common age of onset is 45 to 70 years, with the youngest patient reported so far being only 13 years old. Clinical manifestations Disease symptoms In practice can be manifested in different situations, also called clinical symptoms, mainly including some of the following: 1. Typical patients with acute aortic coarctation often present with sudden, severe, chest and back, tearing-like pain. Severe heart failure, syncope, and even sudden death can occur; most patients are accompanied by uncontrollable hypertension; 2. Occlusion of aortic branch arteries can lead to corresponding ischemic symptoms in the brain, limbs, kidneys, and abdominal organs: such as cerebral infarction, oliguria, abdominal pain, pale legs, weakness, florid spots, and even paraplegia, etc. 3. In addition to the above major symptoms and signs, because of the wide area of aortic blood supply, depending on the entrapment In addition to the above main symptoms and signs, because of the wide area of aortic blood supply, the performance varies according to the accumulation range of the entrapment. The signs and symptoms include mesenteric and renal artery involvement, intestinal paralysis and even necrosis and renal infarction. Pleural effusion is also a common sign of aortic coarctation, mostly on the left side. The greatest risk of aortic coarctation is death. The aorta is the main blood vessel of the body, subjected to pressure directly from the beating heart, with tremendous blood flow. A tear in the intimal layer occurs, and without proper and timely treatment, the chances of rupture are very high and the mortality rate is very high. Previous literature reported mortality rates of up to 50% within 1 week and between 60-70% within a month. In addition to this, even if the patient survives, reduced blood flow to the true luminal vessels due to the enlargement of the false lumen and increased pressure can lead to ischemia of the organs in the area supplied by the aorta. The main tests to confirm the diagnosis of aortic coarctation are CT angiography (CTA), magnetic resonance imaging (MRA) or direct digital silhouette angiography (DSA). I. A plain chest radiograph can provide a clue to the diagnosis. For patients with acute chest and back tear-like pain with hypertension, if a widened upper mediastinal shadow or a widened aortic shadow is found in the chest radiograph, further examinations such as CTA must be performed to clarify the diagnosis. Second, aortic CTA is currently the most commonly used preoperative imaging assessment method with a sensitivity of more than 90% and a specificity close to 100%. CTA tomography can be observed in which the intercalated septum divides the aorta into true and false chambers, and the reconstructed image can provide two-dimensional and three-dimensional images of the entire aorta. Its main drawback is that contrast agent has to be injected and corresponding complications may occur, and the aortic pulsation produces artifacts can also interfere with the image and diagnosis. The diagnostic sensitivity and specificity of aortic MRA for patients with aortic coarctation are close to those of CTA, and the enhancer used in MRI is not nephrotoxic; its disadvantage is that it takes longer to scan and is not suitable for emergency patients with unstable circulatory status, and it is also not suitable for patients with magnetic metal implants in the body. Fourth, digital silhouette angiography (DSA) Currently, although aortic angiography still retains its status as the “gold standard” for the diagnosis of aortic coarctation, it has been largely replaced by CTA and, because it is an invasive test and requires the use of iodine-containing contrast agents, it is currently used only in endoluminal repair procedures and not as a preoperative diagnostic tool. The advantages of ultrasonography are that it is noninvasive, does not require contrast, can locate the endocardial fissure, shows the status of true and false cavities and blood flow, and can also show the complications of aortic valve insufficiency, pericardial effusion and obstruction of branch aortic arch arteries. However, it is also limited by the patient’s obesity and other conditions. Transthoracic ultrasound is easier to perform with simplicity, and its sensitivity and specificity are not as good as transesophageal ultrasound, but transesophageal ultrasound may cause nausea, vomiting, tachycardia and hypertension, which may instead aggravate the condition, and therefore often needs to be performed under anesthesia. Intravascular ultrasound is a diagnostic program developed in recent years, which can clearly display the three-dimensional structure of the aortic lumen and is undoubtedly more accurate than conventional ultrasound in terms of diagnostic accuracy, but because it is an intravascular operation, it is mainly used in the determination of entrapment rupture and residual endoleaks during minimally invasive interventions.