Even with excellent repair, hypertension remains common and pre- disposes to later myocardial infarction, stroke, and HF. See Section 3.3 for recommendations on who should perform surgeries, cardiac catheterization, and other procedures in these patients; Section 3.4 for rec- ommendations on diagnostic evaluation; and Table 21 for routine testing and follow-up intervals. Recommendation-Specific Supportive Text 1. Complications of CoA repair include recoarcta- tion, aneurysm, pseudoaneurysm, and dissection. Long-term follow-up after successful surgical in- tervention for CoA reveals that 11% of patients may require reintervention for restenosis, visual- ized by CMR or CTA (if CMR is contraindicated or there is a history of stent therapy) and supported by physical examination findings.S4.2.6-1 Although Recommendations for Coarctation of the Aorta (Continued) COR LOE Recommendations CLINICAL STATEMENTS AND GUIDELINES evidence of recoarctation can be found on clinical examination and echocardiography, aneurysms near the site of repair may not be well seen by echocardiography. Patients who have undergone surgical patch repair are at an increased risk of developing aneurysms that can be evaluated by CMR or CTA. After successful transcatheter in- tervention with stenting or balloon angioplasty, follow-up CMR or CTA imaging is recommended to evaluate for long-term complications (eg, aneurysm formation, stent fracture, or stent The same CMR or CTA study will also evaluate the ascending aorta, which may be- come aneurysmal over the years of follow-up. 2. Unoperated adults with CoA almost invari- ably present with systemic arterial hypertension measured in the upper extremities. Brachial and femoral pulse timing and amplitude evaluation on physical examination reveals a delay or de- crease in amplitude of the femoral pulse. Upper and lower extremity noninvasive blood pressure measurement is recommended in all patients with unoperated or operated/intervened CoA. 3. 