The Authors report a 49-year-old woman complaining of slight nocturnal lower limb pain in whom an uncommon type IV coarctation of the infrarenal aorta associated with multiple renal arteries, slight hypoplasia of iliac and femoral arteries bilaterally, and a retroaortic left vein were found. She underwent an aorto-aortic prosthetic repair. The correction of this vascular condition was followed by partial improvement of her symptoms. The suspicion of an associated ischaemic spinal origin of these painful symptoms may be suggested by the typical and often complex presence of multiple vascular malformations described in patients with coarctation of the abdominal aorta.