Descending aorta–external iliac artery bypass for middle aortic syndrome

Abstract

We encountered a surgical case of middle aortic syndrome (MAS) in a 56-year-old man who had resistant hypertension. Computed tomography showed severe stenosis of the abdominal aorta from below the superior mesenteric artery to above the inferior mesenteric artery. Although bilateral renal artery stenosis was confirmed, renal function was within normal limits. A 10-mm vascular prosthetic graft was used to perform a descending aorta to left external iliac artery bypass. His hypertension was well controlled without medication. This extra-anatomic bypass may be a simple and useful approach for treating MAS if it is not necessary to reconstruct the renal artery or visceral artery.

Total arch replacement for aortic arch aneurysm with coexisting middle aortic syndrome

“…An extra-anatomical bypass is an effective surgical strategy for managing MAS. The ascending aorta or the descending thoracic aorta can serve as an inflow site for a bypass to the lower abdominal aorta or iliac artery [8]. Hetzer found that an extra-anatomic bypass resulted in good outcomes and provided long-term graft patency in children with MAS [9].…”