Surgical Management of Middle Aortic Syndrome in the Elderly

Coarctation of the distal thoracic aorta and/or the abdominal aorta, namely “middle aortic syndrome” (MAS), is a rare congenital cardiovascular defect with the potential for serious ischemic complications. Diagnosis is usually made during childhood or in young adulthood; therefore, the surgical management of MAS in an elderly patient is exceptional. We report the surgical repair of a MAS in a 65-year-old woman with life-threatening renal and mesenteric ischemia. Using the ascending aorta as bypass inflow, a thoracoabdominal bypass with reimplantation of the visceral vessels was performed through sterno-laparotomy with good result. Therapeutic and technical issues are discussed.