Aortic coarctation is the reflection of a wider vasculopathy affecting the precoarctation arterial tree. Patients should be screened for associated heart disease and anomalies of supra-aortic arch vessels. Treatment options include surgical repair or balloon angioplasty with or without stent-graft implantation. Both treatment options can be complicated by recoarctation or aortic aneurysms and warrant lifelong surveillance. In adults, anatomic correction of coarctation has fewer effects on arterial pressure than in infants. Thus, systemic hypertension may persist in up to half of treated patients. Recoarctation or unrecognized aortic arch hypoplasia should nevertheless be eliminated.