Middle aortic syndrome. Effectiveness and durability of complex arterial revascularization techniques

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Vascular Surgery

Background:

• Middle aortic syndrome (MAS) presents as severe hypertension in young individuals, characterized by diminished femoral pulses and abdominal bruits.
• It stems from diffuse narrowing of the aorta, frequently affecting visceral and renal arteries, leading to significant complications.

Purpose of the Study:

• To evaluate the effectiveness and durability of one-stage revascularization for middle aortic syndrome.
• To assess the impact of surgical intervention on hypertension, renal function, and associated cardiovascular issues.

Main Methods:

• Review of 10 patients (mean age 19.5 years) with MAS who underwent one-stage revascularization.
• Analysis of clinical presentation, angiographic findings, surgical techniques (autogenous and prosthetic), and postoperative outcomes.

Main Results:

• All patients presented with severe hypertension (mean BP 176 mmHg); many had poorly controlled hypertension, renovascular issues, or acute renal failure.
• Angiography revealed high-grade midaortic stenosis with significant visceral and renal artery involvement.
• One-stage revascularization led to uncomplicated recovery in most patients, with dramatic blood pressure reduction and preservation of renal function.

Conclusions:

• One-stage revascularization provides effective and durable relief for the severe complications of middle aortic syndrome.
• The procedure significantly improves hypertension, myocardial insufficiency, and preserves renal function in affected young patients.