Surgical treatment of middle aortic syndrome due to Takayasu arteritis.

A 35-year-old Korean female patient presented with symptoms of postprandial pain and claudication in both lower extremities, with increasing serum creatinine. Her blood pressure at presentation was 170/91 mm Hg on antihypertensive medications, and blood tests showed elevated serum creatinine (2.07 mg/dL) and erythrocyte sedimentation rate (39 mm/dL), and anemia (10.0 g/dL). The C-reactive protein level was within the normal reference range (0.2 mg/dL). A three-dimensional volume-rendered image of a posterior view thoracoabdominal computed tomography (CT) scan showed a heavily calcified distal thoracic and abdominal aorta and a contracted left kidney (A). The axial CT view showed the paravisceral aortic diameter was narrowed to 5.5 mm (B). On a diagnosis of middle aortic syndrome (MAS) due to Takayasu arteritis (TA), we performed an aortic bypass from the ascending aorta to the aortic bifurcation in conjunction with revascularization of the right renal and superior mesenteric arteries. On postoperative day 1, the patient’s serum creatinine level recovered to a normal range and her postprandial abdominal pain subsided. A postoperative CT angiogram showed patent aortic, renal, and mesenteric bypass grafts (C/Cover).