Long-Term Complications in Two Patients After Aortoaortic Bypass for Midaortic Syndrome

Go, Michael R.; Bhende, Siddharth; Smead, William L.; Vaccaro, Patrick S.

doi:10.1016/j.avsg.2012.05.032

Cited by 9 publications

(17 citation statements)

References 17 publications

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“…Indications for surgery are medically refractory hypertension, the presence of symptoms (claudication, intestinal ischemia), and end-organ damage such as renal failure. 5 Optimal management of this patient would have included earlier diagnosis and close follow-up to encourage prompt surgical revascularization. A systematic review of childhood MAS showed that open surgical bypass was twice as frequent as endovascular intervention.…”

Section: Discussionmentioning

confidence: 99%

Surgical management of middle aortic syndrome in an adult

Luu

Pulcrano

Hua

2020

Journal of Vascular Surgery Cases, Innovations and Techniques

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Middle aortic syndrome (MAS), a coarctation of the lower thoracic and/or abdominal aorta, is typically diagnosed and treated in the pediatric population. We present a 48-year-old patient with a long-standing history of hypertension who was lost to follow-up owing to a lack of insurance coverage. After two myocardial infarcts owing to severe hypertension, a vascular workup including a computed tomography angiogram revealed a diagnosis of MAS. He underwent open vascular reconstruction with a thoracoabdominal Dacron bypass graft. He was discharged within 1 week with no hypertension or claudication. Adult patients diagnosed with MAS should undergo open or endovascular surgical repair with close follow-up.

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Section: Discussionmentioning

confidence: 99%

Surgical management of middle aortic syndrome in an adult

Luu

Pulcrano

Hua

2020

Journal of Vascular Surgery Cases, Innovations and Techniques

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“…In addition to aortoaortic bypass, other surgical interventions include patch aortoplasty and primary aortic repair after aortic lengthening 26. Short-term complications of surgical intervention include bleeding and thrombosis while long-term complications include graft infection, restenosis, degradation of the material, enteric fistulas, etc 27. For the patients who have small isolated diseased aortic segments or those who are not surgical candidates, endovascular intervention is an option.…”

Section: Discussionmentioning

confidence: 99%

Unlikely culprit: congenital middle aortic syndrome diagnosed in the sixth decade of life

et al. 2016

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A 58-year-old woman was admitted with acute heart failure. She had a long history of resistant hypertension, with an unremarkable work up for secondary causes in the past. Her brachial blood pressure was 210/70 mm Hg, with ankle blood pressure of 100/70 mm Hg. CT angiogram revealed marked narrowing of the descending thoracic aorta between the left subclavian artery and the diaphragm, consistent with middle aortic syndrome (MAS). She was initially managed with diuretics and antihypertensives. Subsequently thoracotomy revealed a severely hypoplastic segment of the descending aorta. The diseased segment was resected and aortic reconstruction performed. Histopathology showed fragmentation of the medial elastic fibres and fibrosis of the medial and intimal layers. These findings along with gross aortic hypoplasia and absence of features of Takayasu's arteritis, suggest that our patient had congenital MAS. The patient has done well since her surgery. We believe this is the first case of congenital MAS reported in the sixth decade of life.

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“…Delayed aneurysmal degeneration, thrombosis, and graft-enteric fistula formation are rare but reported complications. 52 While no consensus recommendations for postsurgical MAS reconstruction imaging surveillance have been established, the authors suggest CTA or MRA within 1 year and then every 5 years thereafter as extrapolated from adult abdominal aortic aneurysm repair. 53…”

Section: Surgical Interventionmentioning

confidence: 99%

Middle Aortic Syndrome: Pathogenesis, Visceral Manifestations, and Management

et al. 2018

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Middle aortic syndrome (MAS) is characterized by severe narrowing of the abdominal aorta, frequently involving the great abdominal vessels. Although increasingly implicated in primary hypertension, up to one-third of cases affect the mesenteric vasculature, and the resultant manifestations may be underrecognized. Early intervention with interdisciplinary medical management and invasive arterial reconstruction affords preservation of end-organ function and improvement in patient survival. This article reviews the embryology of the thoracoabdominal aorta and major abdominal arteries, as well as the pathogenesis, clinical manifestations, and management of the nonatherosclerotic abdominal coarctation otherwise known as MAS.

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Long-Term Complications in Two Patients After Aortoaortic Bypass for Midaortic Syndrome

Cited by 9 publications

References 17 publications

Surgical management of middle aortic syndrome in an adult

Surgical management of middle aortic syndrome in an adult

Unlikely culprit: congenital middle aortic syndrome diagnosed in the sixth decade of life

Middle Aortic Syndrome: Pathogenesis, Visceral Manifestations, and Management

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