Severe midaortic syndrome: a stepwise approach to treatment with drug-eluting balloons: a case report

Abstract

Background Severe forms of the midaortic syndrome cause persistent arterial hypertension and can lead to angina abdominalis. Untreated, morbidity, and mortality are significant. In addition to palliation through bypass surgery, few other therapeutic approaches lead to a long-term relief. Drug-eluting balloons (DEB) covered with paclitaxel, a cytostatic drug, have proven to be effective in bifurcational lesions and for in-stent stenoses in coronary arteries. Case summary In a 15-year-old girl with severe midaortic syndrome and multiple collateral arteries, four interventional balloon dilatations with DEB of increasing diameters resolved the stenosis within 8 months. After a procedure free interval of now 2.7 years, the anatomical and the physical condition of the patient remained unchanged. Discussion This stepwise approach, with a low procedural risk and a lasting result may justify further investigations into this combined treatment.

Sindrome de Aorta media en Pediatría

“…-Tratamiento endovascular: Los procedimientos endovasculares se realizan con menor frecuencia en comparación con los quirúrgicos. Las dos técnicas mayormente utilizadas son la dilatación con balón y la endoprótesis vascular (2,9,15). La tasa de reintervención para el abordaje endovascular a los 5 años de seguimiento alcanza hasta un 67%, el factor más común es la reestenosis en la endoprótesis vascular.…”

“…Existen diversas técnicas quirúrgicas, y su elección depende de factores como, la ubicación de la estenosis, la longitud del segmento afectado, así como el compromiso de vasos viscerales (2,3). Dentro de los métodos quirúrgicos se encuentran la derivación aortoaórtica, la angioplastía utilizando injerto protésico y la reparación aórtica primaria posterior al alargamiento aórtico (1)(2)(3)9,13,15). A pesar de la posible efectividad en el uso de material protésico, en el paciente pediátrico se evita en la medida de lo posible, ya que podría requerir procedimientos adicionales debido al crecimiento somático.…”

Diagnosis and Management of Genetic Causes of Middle Aortic Syndrome in Children: A Comprehensive Literature Review

“…Repeated balloon dilations with paclitaxel eluting balloons have demonstrated to be an effective and safe therapeutic option in a 15-year-old patient. 34 Younger age at the time of intervention could be a risk factor for vascular complication because patients who are diagnosed in the first years of life has a severe form of disease. 3 Surgical procedures are indicated when endovascular interventions fail to achieve the long-term blood pressure values control or when the lesions are too complex for percutaneous transluminal angioplasty.…”