title: Aortic bypass and bilateral renal autotransplantation for mid-aortic syndrome.
abstract: BACKGROUND
  Middle aortic syndrome (MAS) is a rare condition characterized by stenosis of the proximal abdominal aorta and the origin of the renal and digestive arteries. When medical therapy and interventional radiology fail to control threatening reno-vascular arterial hypertension (AHT), surgery is required and may need several interventions, which are usually delayed until late childhood.
  
  
  METHODS
  We report on a 3-year-old girl with severe AHT (180/130 mmHg) caused by MAS. There was no evidence of generalized vascular disease or complications of AHT. AHT failed to respond to medical therapy (five drugs), endovascular dilatation, and stenting was considered unfeasible due to the complex multiple strictures. Surgery consisted of: explantation of the two kidneys; aortic bypass between the lower thoracic and lower abdominal aorta using a prosthetic graft; reimplantation of the kidneys onto the normal iliac arteries. The post-operative course was uneventful. Owing to recurrent stenosis of the re-implanted renal arteries, endoluminal dilatations were performed 4 and 5 months after surgery. Two years after surgery, the child is alive and well, off anti-hypertensive therapy, with normal blood pressure.
  
  
  CONCLUSIONS
  Mild aortic syndrome can be treated with a one-stage surgical repair with aorto-aortic bypass and bilateral auto-transplantation, even in young children.
authors.affiliation: Pediatric Surgery unit, Hôpital Necker-Enfants malades, 149 rue de Sèvres, 75015, Paris, France.
authors.forename: Anna
authors.initials: A
authors.lastname: Poupalou
authors.forename: Rémi
authors.initials: R
authors.lastname: Salomon
authors.forename: Younes
authors.initials: Y
authors.lastname: Boudjemline
authors.forename: Emma
authors.initials: E
authors.lastname: Allain-Launay
authors.forename: Yves
authors.initials: Y
authors.lastname: Aigrain
authors.forename: Christophe
authors.initials: C
authors.lastname: Chardot
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D001012:Aorta, Abdominal / Q000002:abnormalities*; D001018:Aortic Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D002675:Child, Preschool; D003251:Constriction, Pathologic; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000209:etiology / Q000601:surgery; D016030:Kidney Transplantation / Q000379:methods*; D012077:Renal Artery / Q000601:surgery; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013577:Syndrome; D014057:Tomography, X-Ray Computed; D014182:Transplantation, Autologous; D017211:Treatment Failure; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000959:Antihypertensive Agents