Middle Aortic Syndrome

Abstract

A 46-year-old female patient was admitted with signs of lower limb ischemia. Her examination demonstrated a nonpalpable distal pulse. Computed tomography angiography revealed an anomalous origin of both renal arteries (A, B) and severe aortic narrowing between the renal arteries, confirmed by the angiogram (C). The diagnosis was middle aortic syndrome (1). Endovascular treatment was decided on, and a balloon-expandable covered stent (Jomed, Abbott Laboratories, Abbott Park, Illinois) was placed, with good stent expansion (D). Physical examination revealed distal pulse recovery. At 5 months, the patient remains asymptomatic. Computed tomography angiography showed stent patency (E, F). Middle aortic syndrome refers to an isolated disease of the thoracoabdominal aorta causing segmental narrowing. It is often associated with hypertension in childhood. This is a rare case of middle aortic syndrome with lower limb ischemia successfully resolved with endovascular treatment. REFERENCE 1. González-Ferrer JJ, Balbacid E, Vilacosta I. Middle aortic syndrome, severe hypertension, and endovascular repair. Eur Heart J 2009;30:1553.