1. Midaortic syndrome: 30 years of experience with medical, endovascular and surgical management.
- Author
-
Porras D, Stein DR, Ferguson MA, Chaudry G, Alomari A, Vakili K, Fishman SJ, Lock JE, and Kim HB
- Subjects
- Adolescent, Adult, Antihypertensive Agents adverse effects, Aorta, Abdominal physiopathology, Aortic Diseases diagnosis, Aortic Diseases drug therapy, Aortic Diseases physiopathology, Aortic Diseases surgery, Arterial Occlusive Diseases diagnosis, Arterial Occlusive Diseases drug therapy, Arterial Occlusive Diseases physiopathology, Arterial Occlusive Diseases surgery, Arterial Pressure drug effects, Boston, Child, Child, Preschool, Combined Modality Therapy, Constriction, Pathologic, Female, Humans, Hypertension diagnosis, Hypertension drug therapy, Hypertension physiopathology, Hypertension surgery, Infant, Infant, Newborn, Kaplan-Meier Estimate, Male, Retrospective Studies, Syndrome, Time Factors, Treatment Outcome, Young Adult, Antihypertensive Agents therapeutic use, Aorta, Abdominal drug effects, Aorta, Abdominal surgery, Aortic Diseases therapy, Arterial Occlusive Diseases therapy, Endovascular Procedures adverse effects, Hypertension therapy, Vascular Surgical Procedures adverse effects
- Abstract
Background: Midaortic syndrome is often associated with refractory hypertension. The aim of our study was to better understand the short- and medium-term outcomes in this patient population utilizing a multidisciplinary management approach., Methods: We conducted a review of patients with midaortic syndrome treated at our institution over the past 30 years., Results: Fifty-three patients presented at a median age of 6.7 years (birth to 28.7 years). Thirty-five patients (66 %) underwent invasive management (percutaneous techniques: 21; surgical techniques: 5; both: 9). Percutaneous interventions were acutely successful in decreasing the gradient across the obstruction and degree of luminal stenosis. However, freedom from reintervention was 58 % at 1 year and 33 % at 5 years. Freedom from reintervention after a surgical procedure was longer: 83 % at 1 year and 72 % at 10 years. At the most recent follow-up, the majority of patients (69 %) were normotensive. The median duration between time of presentation and achievement of blood pressure control was 5.7 (0.4-21.1) years. The median number of anti-hypertensive medications was 1 (0-5)., Conclusions: A multidisciplinary management strategy which couples comprehensive medical management with catheter-based and surgical interventions can lead to adequate blood pressure control and preservation of end-organ function in patients with midaortic syndrome.
- Published
- 2013
- Full Text
- View/download PDF