Overview
Mid-aortic syndrome (MAS) is characterized by narrowing of the abdominal aorta and its major branches, often involving renal arteries, leading to diverse clinical manifestations including hypertension, claudication, and ischemia 3.Diagnosis
Clinical Presentation: Hypertension (94%), claudication (17%), renal failure (4%), intestinal ischemia (1%) 3.
Physical Examination: Blood pressure discrepancy between upper and lower extremities, diminished or absent lower extremity pulsations 1.
Diagnostic Imaging: Angiography is the preferred imaging modality for definitive diagnosis 3.Management
Initial Management: Conservative blood pressure control with medical therapy 3.
Medical Therapy: Refractory cases may require specific antihypertensive agents; specific drug classes/doses not detailed 3.
Surgical Intervention: Indicated when medical control fails, renal function is compromised, or symptoms of claudication or intestinal ischemia persist 3.Special Populations
Pediatrics: MAS can present in neonates and preterm infants, often with severe outcomes like refractory hypertension and early mortality 23.
Comorbidities: Refractory hypertension and renal involvement are common, necessitating careful monitoring and management 13.Key Recommendations
Perform thorough blood pressure measurements and physical examination to detect discrepancies indicative of mid-aortic syndrome (Evidence: Moderate 1).
Utilize angiography for definitive diagnosis of mid-aortic syndrome (Evidence: Moderate 3).
Initiate conservative management with antihypertensive therapy for blood pressure control; consider surgical intervention if medical management fails or complications arise (Evidence: Weak 3).References
1 ten Dam K, van der Palen RL, Tanke RB, Schreuder MF, de Jong H. Clinical recognition of mid-aortic syndrome in children. European journal of pediatrics 2013. link
2 Izraelit A, Kim M, Ratner V, Levasseur SM, Seigle R, Krishnamurthy G. Mid-aortic syndrome in two preterm infants. Journal of perinatology : official journal of the California Perinatal Association 2012. link
3 Sethna CB, Kaplan BS, Cahill AM, Velazquez OC, Meyers KE. Idiopathic mid-aortic syndrome in children. Pediatric nephrology (Berlin, Germany) 2008. link