Abstract
Background
Mid-aortic syndrome (MAS), characterized by segmental stricture of the distal thoracic
and abdominal aorta, is a heterogeneous clinical syndrome with multiple etiologies.
Methods
We retrospectively analyzed 143 consecutive patients (99 females and 44 males, mean
age 40.93 ± 15.31 years) with MAS seen from January 1, 2010 to January 1, 2019.
Results
Takayasu arteritis (76.9%, 110/143) and atherosclerosis (19.6%, 28/143) were the most-common
causes. There were also one patient with Behçet's disease and one with congenital
MAS in the cohort. Hypertension was the most-common manifestation. Constitutional
symptoms were mainly seen in Takayasu arteritis, and neurological, gastrointestinal
and vascular symptoms were common in both Takayasu arteritis and atherosclerosis.
The infrarenal segment was the most-commonly involved in atherosclerosis (89.3%, 25/28),
whereas lesions were more distributed in Takayasu arteritis. The mean length of involved
segments was longer (43.45 ± 23.64 mm vs. 30.68 ± 12.66 mm; P = 0.018) and the degree of stenosis was lower (80.20 ± 13.36% vs. 87.50 ± 13.95%,
P = 0.004) in Takayasu arteritis than atherosclerosis. The most-common concurrently
involved branch was the renal artery, followed by the celiac trunk and mesenteric
arteries, in both Takayasu arteritis (51.8%, 32.7% and 27.3%, respectively) and atherosclerosis
(53.6%, 25.0% and 17.9%, respectively). Concurrent artery involvement and coexisting
lesions were absent in MAS caused by congenial coarctation of the abdominal aorta
and Behçet's disease.
Conclusions
Takayasu arteritis and atherosclerosis were the most-common causes of MAS among these
adults. Imaging tests provided evidence of involved segments and luminal and mural
changes, aiding conclusive diagnoses and etiological differentiation of MAS.
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Article info
Publication history
Published online: April 12, 2022
Accepted:
April 6,
2022
Received:
September 22,
2020
Identification
Copyright
© 2023 Published by Elsevier Inc. on behalf of Southern Society for Clinical Investigation.
