Editor's Choice - Therapeutic Options and Outcomes in Midaortic Syndrome: A Systematic Review and Meta-analysis

Parallel endograft repair of an aortic anastomotic pseudoaneurysm in a patient with middle aortic syndrome

A 66-year-old female, with a history of middle aortic syndrome, who had been treated with aorto-iliac bypass, presented 47 years later with a pseudoaneurysm at the distal anastomosis. She was treated with parallel grafting and preservation of a large lumbar artery via periscope approach. This case highlights the challenges and considerations in managing aortic anastomotic pseudoaneurysms, particularly in patients with complex surgical histories with extra-anatomic debranching bypasses.

[MEP-24] Middle Aortic Syndrome in An Adult Presenting with Limb Ischemia

Middle aortic syndrome (MAS) is a segmental narrowing of the distal descending thoracic or abdominal aorta. This rare condition accounts for 0.5 to 2% of aortic coarctations. Middle aortic syndrome may be acquired, caused by Takayasu arteritis or giant cell arteritis, neurofibromatosis, fibromuscular dysplasia, retroperitoneal fibrosis, mucopolysaccharidosis, and the Williams syndrome, or it may be congenital. Stenosis is usually located at the suprarenal, interrenal, or infrarenal aorta. Concomitant stenoses in the renal (63%) and visceral (33%) arteries may be encountered. In this case report, we presented a 66-year-old male patient with MAS. The patient's primary complaint was claudication and rest pain in the last three months. The patient had hypertension for two years and a history of lumbar disc hernia operation. Thoracoabdominal computed tomography angiography revealed an enlarged ascending aorta, an aberrant right subclavian artery, and a narrowed segment with an hourglass appearance in the infrarenal aorta. The vessel diameter decreased to 9×10 mm at this level, and both iliac arteries were occluded distally. The patient underwent aortobifemoral bypass surgery with a 14/7 mm Dacron graft. In the postoperative period, all distal pulses were palpable, and leg pain resolved. The patient was discharged from the hospital on the sixth day without complications. This case report presented an adult MAS patient with rest pain in the legs related to occluded iliac arteries and aortic bifurcation. The coarctation in the infrarenal aorta was successfully treated by open surgery (aortobifemoral bypass). Children may benefit more from early diagnosis before the onset of severe hypertension. Open surgery is the primary treatment modality for tubular MAS. Usually bypass of the diseased segment or, less often, patch angioplasty is preferred. Bypass grafting of the stenosed renal and visceral arteries is performed when necessary. Endovascular therapy may provide less invasive treatment.

Surgical Strategies and Long-Term Outcomes for Complex Coral Reef Aorta with Multisegmental Involvement: A Case Report

Coral reef aorta (CRA) is a rare condition characterized by the distribution of rock-hard calcifications in the visceral part of the aorta, leading to potentially life-threatening symptoms, such as hypertension, congestive heart failure, and limb and visceral ischemia. The patient was a 54-year-old female who presented with leg claudication and was diagnosed with CRA using computed tomography. CRA affected the descending thoracic and abdominal aortas, including the visceral portion, leading to reduced perfusion of both limbs and the left kidney. The surgical intervention involved bypass surgery from the descending thoracic aorta proximal to the CRA to the aortic bifurcation, including reimplantation of the left renal artery. Postoperative recovery was successful and the symptoms resolved. However, the patient experienced decreased right renal function due to CRA progression three years postoperatively. Given the uncertainty regarding the optimal surgical approach for CRA, long-term considerations are crucial for its management.