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A Journal on Surgery

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Chirurgia 2010 February;23(1):15-9

language: English

Mid-aortic syndrome: cause of a pancreaticoduodenal aneurysm

Verbrugge F.H., Lansink W., Stockx L., Lauwers G., Vanslembroek K, Schepers S., Schroë H.

ZOL Campus Sint - Jan, Genk, Belgium


Aim. Mid-aortic syndrome, although an uncommon disorder, should be in the differential diagnosis of renovascular hypertension in children and adolescents. The purpose of this case is to discuss optimal treatment in an exceptional case of mid-aortic syndrome, complicated with a flow-related aneurysm of the pancreaticoduodenal artery.
Case report. A 20-year-old Caucasian girl presented with asymptomatic hypertension, refractory to medical treatment. Ultrasonography failed to demonstrate renovascular disease. Computed tomographic angiography revealed a mid-aortic syndrome, with a right renal artery stenosis. The celiac trunk and superior mesenteric artery were also significantly narrowed. Furthermore, a visceral aneurysm was discovered. On digital subtraction angiography, this aneurysm was located on the pancreaticoduodenal artery. Percutaneous transluminal angioplasty failed as an initial approach to treat renovascular hypertension. So the patient received a surgical vascular reconstruction. This resolved hypertension and abled us to perform a safe endovascular coil embolization of the pancreaticoduodenal aneurysm.
Conclusion. Single-staged vascular surgery is the preferred course of action in stenotic, symptomatic, mid-aortic syndrome lesions. Percutaneous transluminal angioplasty does not have short-term nor long-term success because of the resistance of the extensive fibrosis in MAS lesions to endovascular treatment.Coil embolization is an excellent way to treat a pancreaticoduodenal artery aneurysm. However, a celiac trunk stenosis, as seen in mid-aortic syndrome, can seriously hamper endovascular treatment. In that case, a surgical vascular reconstruction can be the solution.

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