Middle aortic syndrome with renal involvement: a staged strategy to manage systemic hypertension

Long segment narrowing of the thoracoabdominal aorta or so-called middle aortic syndrome (MAS), is an uncommon lesion presenting variably with physical signs of coarctation of the aorta, hypertension, renal insufficiency and or mesenteric ischemia. The etiologies are multiple, but Takayasu's arteritis is a leading cause. Variable involvement of diverse systemic arterial systems requires individualized management strategies. We report a case of a successful treatment algorithm for severe MAS using a strategy of percutaneous aortic endovascular stent implantation to rebuild the distal aorta and renal auto-implantation to address systemic hypertension.