Abstract：
BACKGROUND: Middle aortic syndrome is a rare disease. Several surgical treatments are available; however, the optimal treatment strategy and long-term outcomes remain unelucidated. We herein report the 5-year outcomes of six patients treated with extra-anatomical bypass surgery for middle aortic syndrome.
METHODS: Between 2013 and 2016, six patients underwent extra-anatomical bypass for middle aortic syndrome at our institute: three had Takayasu\'s arteritis, one had vessel vasculitis, and two had middle aortic hypoplastic syndrome of unknown origin. The patients included five women and one man, with a mean age of 59.7 years. Four patients had uncontrolled hypertension and were receiving antihypertensive medications. The mean ankle-brachial pressure index was .61. The three patients with Takayasu\'s arteritis were hospitalized for congestive heart failure. These patients underwent bypass surgery from the descending aorta to the infrarenal abdominal aorta, and one also underwent concomitant heart surgery. The patient with microscopic polyangiitis underwent Y-grafting with an aortic aneurysmectomy. Subsequently, bypass surgery was performed from the descending aorta to the graft via the diaphragm. The two patients with unknown causes underwent bypass surgery from the proximal descending aorta to the distal descending thoracic aorta. There were no early or late deaths at the 5-year follow-up. We did not observe any changes in anastomotic site stenosis or new aneurysmal changes during the follow-up period. The number of antihypertensive medications was reduced in all cases, and critical symptoms, including headache, severe abdominal pain, claudication, and heart failure, improved in all patients. The ankle-brachial pressure index increased to 1.11 and did not change for five years. Renal function remained stable, and the brain natriuretic peptide level decreased from 302.8 to 74.5 pg/mL at follow-up.
CONCLUSIONS: Extra-anatomical bypass for middle aortic syndrome is safe and effective, and can help prevent renal failure, and relieve critical ischemic symptoms.
METHODS: Between 2013 and 2016, six patients underwent extra-anatomical bypass for middle aortic syndrome at our institute: three had Takayasu\'s arteritis, one had vessel vasculitis, and two had middle aortic hypoplastic syndrome of unknown origin. The patients included five women and one man, with a mean age of 59.7 years. Four patients had uncontrolled hypertension and were receiving antihypertensive medications. The mean ankle-brachial pressure index was .61. The three patients with Takayasu\'s arteritis were hospitalized for congestive heart failure. These patients underwent bypass surgery from the descending aorta to the infrarenal abdominal aorta, and one also underwent concomitant heart surgery. The patient with microscopic polyangiitis underwent Y-grafting with an aortic aneurysmectomy. Subsequently, bypass surgery was performed from the descending aorta to the graft via the diaphragm. The two patients with unknown causes underwent bypass surgery from the proximal descending aorta to the distal descending thoracic aorta. There were no early or late deaths at the 5-year follow-up. We did not observe any changes in anastomotic site stenosis or new aneurysmal changes during the follow-up period. The number of antihypertensive medications was reduced in all cases, and critical symptoms, including headache, severe abdominal pain, claudication, and heart failure, improved in all patients. The ankle-brachial pressure index increased to 1.11 and did not change for five years. Renal function remained stable, and the brain natriuretic peptide level decreased from 302.8 to 74.5 pg/mL at follow-up.
CONCLUSIONS: Extra-anatomical bypass for middle aortic syndrome is safe and effective, and can help prevent renal failure, and relieve critical ischemic symptoms.
摘要：
背景：中主动脉综合征是一种罕见疾病。有几种手术治疗方法可用；然而，最佳治疗策略和长期结局仍未阐明.我们在此报告了6例接受解剖外搭桥手术治疗的中主动脉综合征患者的5年结局。
方法：在2013年至2016年之间，我们研究所有6例患者接受了中主动脉综合征的解剖外搭桥：3例患有Takayasu的动脉炎，其中一人患有血管血管炎，两名患有不明原因的中主动脉增生综合征。患者包括五名女性和一名男性，平均年龄59.7岁.四名患者的高血压不受控制，正在接受抗高血压药物治疗。平均踝臂压指数为.61。3例大动脉炎患者因充血性心力衰竭住院。这些患者接受了从降主动脉到肾下腹主动脉的搭桥手术，其中一人还接受了心脏手术。显微镜下多血管炎患者接受了Y型移植和主动脉瘤切除术。随后，旁路手术从降主动脉经膈至移植物.两名原因不明的患者接受了从近端降主动脉到远端降主动脉的旁路手术。在5年的随访中没有早期或晚期死亡。在随访期间，我们没有观察到吻合部位狭窄的任何变化或新的动脉瘤变化。在所有情况下，抗高血压药物的数量都减少了，和严重的症状，包括头痛,严重的腹痛,跛行,心力衰竭,改善所有患者。踝臂压指数增加到1.11，并且五年没有变化。肾功能保持稳定,随访时脑钠肽水平从302.8降至74.5pg/mL。
结论：解剖外分流术治疗中主动脉综合征是安全有效的，可以帮助预防肾衰竭，缓解严重的缺血症状.
方法：在2013年至2016年之间，我们研究所有6例患者接受了中主动脉综合征的解剖外搭桥：3例患有Takayasu的动脉炎，其中一人患有血管血管炎，两名患有不明原因的中主动脉增生综合征。患者包括五名女性和一名男性，平均年龄59.7岁.四名患者的高血压不受控制，正在接受抗高血压药物治疗。平均踝臂压指数为.61。3例大动脉炎患者因充血性心力衰竭住院。这些患者接受了从降主动脉到肾下腹主动脉的搭桥手术，其中一人还接受了心脏手术。显微镜下多血管炎患者接受了Y型移植和主动脉瘤切除术。随后，旁路手术从降主动脉经膈至移植物.两名原因不明的患者接受了从近端降主动脉到远端降主动脉的旁路手术。在5年的随访中没有早期或晚期死亡。在随访期间，我们没有观察到吻合部位狭窄的任何变化或新的动脉瘤变化。在所有情况下，抗高血压药物的数量都减少了，和严重的症状，包括头痛,严重的腹痛,跛行,心力衰竭,改善所有患者。踝臂压指数增加到1.11，并且五年没有变化。肾功能保持稳定,随访时脑钠肽水平从302.8降至74.5pg/mL。
结论：解剖外分流术治疗中主动脉综合征是安全有效的，可以帮助预防肾衰竭，缓解严重的缺血症状.
