A case of atypical aortic coarctation with refractory congestive heart failure--treatment with axillo-iliac artery bypass

Midaortic Syndrome due to Takayasu Arteritis in a Child with Acute Decompensated Cardiac Failure Managed by an Emergency Axillo-External Iliac Artery Bypass: A Follow-Up Case Report of Long-Term Outcomes

Midaortic syndrome (MAS) is characterized by a diffuse narrowing of the distal thoracic or abdominal aorta and is concomitant with various etiologies. The common symptoms of MAS include severe hypertension or arterial insufficiency distal to the stenosis. This includes lower extremity claudication and heart failure due to afterload mismatch. We present the case of an 8-year-old girl who developed acute decompensated cardiac, respiratory, and renal failures because of the occlusion of the descending aorta secondary to Takayasu arteritis (TA). Although thoracoabdominal-aortic bypass is usually performed for patients with MAS, the procedure was considered too invasive, given the patient's condition. Therefore, we performed an emergency axillo-external iliac artery bypass for revascularization. Subsequently, organ failure improved and she was discharged. At postoperative 10 years, an asymptomatic pseudoaneurysm was detected at the distal anastomosis, for which revision surgery was performed. Overall, the long-term prognosis was satisfactory, suggesting that this procedure is less invasive and effective for treatment of MAS due to TA, in emergencies.

A New Extra-anatomical Bypass for Atypical Aortic Coarctation with Porcelain Aorta: Reno-iliac Arterial Bypass

We report a case of atypical aortic coarctation with severe calcification of the proximal aorta treated by a new extra-anatomical bypass. This 58-year-old woman with coarctation of the infrarenal aorta had thick circular calcifications of the thoracic aorta and stenosis of the subclavian arteries. To control the progressive claudication, we performed a bypass with an externally supported PTFE graft 6mm in diameter between the right renal artery and the right common iliac artery. Postoperative ankle pressure rose to 84 mmHg (right) and 89 mmHg (left) from zero, and she could walk without pain. Renal function was preserved. Using the proximal anastomosis from the non-diseased aortic branch to avoid the calcified aorta, reno-iliac arterial bypass is a useful alternative for control of ischemic lower limbs.