Midaortic syndrome: 30 years of experience with medical, endovascular and surgical management
Background Midaortic syndrome is often associated with refractory hypertension. The aim of our study was to better understand the short- and medium-term outcomes in this patient population utilizing a multidisciplinary management approach. Methods We conducted a review of patients with midaortic syn...
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| Veröffentlicht in: | Pediatric nephrology (Berlin, West) West), 2013-10, Vol.28 (10), p.2023-2033 |
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| container_title | Pediatric nephrology (Berlin, West) |
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| creator | Porras, Diego Stein, Deborah R. Ferguson, Michael A. Chaudry, Gulraiz Alomari, Ahmad Vakili, Khashayar Fishman, Steven J. Lock, James E. Kim, Heung B. |
| description | Background
Midaortic syndrome is often associated with refractory hypertension. The aim of our study was to better understand the short- and medium-term outcomes in this patient population utilizing a multidisciplinary management approach.
Methods
We conducted a review of patients with midaortic syndrome treated at our institution over the past 30 years.
Results
Fifty-three patients presented at a median age of 6.7 years (birth to 28.7 years). Thirty-five patients (66 %) underwent invasive management (percutaneous techniques: 21; surgical techniques: 5; both: 9). Percutaneous interventions were acutely successful in decreasing the gradient across the obstruction and degree of luminal stenosis. However, freedom from reintervention was 58 % at 1 year and 33 % at 5 years. Freedom from reintervention after a surgical procedure was longer: 83 % at 1 year and 72 % at 10 years. At the most recent follow-up, the majority of patients (69 %) were normotensive. The median duration between time of presentation and achievement of blood pressure control was 5.7 (0.4–21.1) years. The median number of anti-hypertensive medications was 1 (0–5).
Conclusions
A multidisciplinary management strategy which couples comprehensive medical management with catheter-based and surgical interventions can lead to adequate blood pressure control and preservation of end-organ function in patients with midaortic syndrome. |
| doi_str_mv | 10.1007/s00467-013-2514-8 |
| format | Article |
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Midaortic syndrome is often associated with refractory hypertension. The aim of our study was to better understand the short- and medium-term outcomes in this patient population utilizing a multidisciplinary management approach.
Methods
We conducted a review of patients with midaortic syndrome treated at our institution over the past 30 years.
Results
Fifty-three patients presented at a median age of 6.7 years (birth to 28.7 years). Thirty-five patients (66 %) underwent invasive management (percutaneous techniques: 21; surgical techniques: 5; both: 9). Percutaneous interventions were acutely successful in decreasing the gradient across the obstruction and degree of luminal stenosis. However, freedom from reintervention was 58 % at 1 year and 33 % at 5 years. Freedom from reintervention after a surgical procedure was longer: 83 % at 1 year and 72 % at 10 years. At the most recent follow-up, the majority of patients (69 %) were normotensive. The median duration between time of presentation and achievement of blood pressure control was 5.7 (0.4–21.1) years. The median number of anti-hypertensive medications was 1 (0–5).
Conclusions
A multidisciplinary management strategy which couples comprehensive medical management with catheter-based and surgical interventions can lead to adequate blood pressure control and preservation of end-organ function in patients with midaortic syndrome.</description><identifier>ISSN: 0931-041X</identifier><identifier>EISSN: 1432-198X</identifier><identifier>DOI: 10.1007/s00467-013-2514-8</identifier><identifier>PMID: 23775038</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adolescent ; Adult ; Age ; Angioplasty ; Antihypertensive Agents - adverse effects ; Antihypertensive Agents - therapeutic use ; Aorta, Abdominal - drug effects ; Aorta, Abdominal - physiopathology ; Aorta, Abdominal - surgery ; Aortic Diseases - diagnosis ; Aortic Diseases - drug therapy ; Aortic Diseases - physiopathology ; Aortic Diseases - surgery ; Aortic Diseases - therapy ; Arterial Occlusive Diseases - diagnosis ; Arterial Occlusive Diseases - drug therapy ; Arterial Occlusive Diseases - physiopathology ; Arterial Occlusive Diseases - surgery ; Arterial Occlusive Diseases - therapy ; Arterial Pressure - drug effects ; Blood pressure ; Boston ; Cardiology ; Care and treatment ; Catheters ; Child ; Child, Preschool ; Combined Modality Therapy ; Complications and side effects ; Constriction, Pathologic ; Coronary vessels ; Endovascular Procedures - adverse effects ; Female ; Hospitals ; Humans ; Hypertension ; Hypertension - diagnosis ; Hypertension - drug therapy ; Hypertension - physiopathology ; Hypertension - surgery ; Hypertension - therapy ; Infant ; Infant, Newborn ; Kaplan-Meier Estimate ; Male ; Medical schools ; Medicine ; Medicine & Public Health ; Mortality ; Nephrology ; Original Article ; Patient outcomes ; Patients ; Pediatrics ; Renal artery obstruction ; Retrospective Studies ; Risk factors ; Syndrome ; Time Factors ; Treatment Outcome ; Urology ; Vascular Surgical Procedures - adverse effects ; Veins & arteries ; Young Adult</subject><ispartof>Pediatric nephrology (Berlin, West), 2013-10, Vol.28 (10), p.2023-2033</ispartof><rights>IPNA 2013</rights><rights>COPYRIGHT 2013 Springer</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c551t-4fc0dcd22c2e5808160669bb1b9034197ea68b0f5025b31cf7f57e4a258a7a0d3</citedby><cites>FETCH-LOGICAL-c551t-4fc0dcd22c2e5808160669bb1b9034197ea68b0f5025b31cf7f57e4a258a7a0d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00467-013-2514-8$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00467-013-2514-8$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23775038$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Porras, Diego</creatorcontrib><creatorcontrib>Stein, Deborah R.</creatorcontrib><creatorcontrib>Ferguson, Michael A.</creatorcontrib><creatorcontrib>Chaudry, Gulraiz</creatorcontrib><creatorcontrib>Alomari, Ahmad</creatorcontrib><creatorcontrib>Vakili, Khashayar</creatorcontrib><creatorcontrib>Fishman, Steven J.</creatorcontrib><creatorcontrib>Lock, James E.</creatorcontrib><creatorcontrib>Kim, Heung B.</creatorcontrib><title>Midaortic syndrome: 30 years of experience with medical, endovascular and surgical management</title><title>Pediatric nephrology (Berlin, West)</title><addtitle>Pediatr Nephrol</addtitle><addtitle>Pediatr Nephrol</addtitle><description>Background
Midaortic syndrome is often associated with refractory hypertension. The aim of our study was to better understand the short- and medium-term outcomes in this patient population utilizing a multidisciplinary management approach.
Methods
We conducted a review of patients with midaortic syndrome treated at our institution over the past 30 years.
Results
Fifty-three patients presented at a median age of 6.7 years (birth to 28.7 years). Thirty-five patients (66 %) underwent invasive management (percutaneous techniques: 21; surgical techniques: 5; both: 9). Percutaneous interventions were acutely successful in decreasing the gradient across the obstruction and degree of luminal stenosis. However, freedom from reintervention was 58 % at 1 year and 33 % at 5 years. Freedom from reintervention after a surgical procedure was longer: 83 % at 1 year and 72 % at 10 years. At the most recent follow-up, the majority of patients (69 %) were normotensive. The median duration between time of presentation and achievement of blood pressure control was 5.7 (0.4–21.1) years. The median number of anti-hypertensive medications was 1 (0–5).
Conclusions
A multidisciplinary management strategy which couples comprehensive medical management with catheter-based and surgical interventions can lead to adequate blood pressure control and preservation of end-organ function in patients with midaortic syndrome.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Age</subject><subject>Angioplasty</subject><subject>Antihypertensive Agents - adverse effects</subject><subject>Antihypertensive Agents - therapeutic use</subject><subject>Aorta, Abdominal - drug effects</subject><subject>Aorta, Abdominal - physiopathology</subject><subject>Aorta, Abdominal - surgery</subject><subject>Aortic Diseases - diagnosis</subject><subject>Aortic Diseases - drug therapy</subject><subject>Aortic Diseases - physiopathology</subject><subject>Aortic Diseases - surgery</subject><subject>Aortic Diseases - therapy</subject><subject>Arterial Occlusive Diseases - diagnosis</subject><subject>Arterial Occlusive Diseases - drug therapy</subject><subject>Arterial Occlusive Diseases - physiopathology</subject><subject>Arterial Occlusive Diseases - surgery</subject><subject>Arterial Occlusive Diseases - therapy</subject><subject>Arterial Pressure - drug effects</subject><subject>Blood pressure</subject><subject>Boston</subject><subject>Cardiology</subject><subject>Care and treatment</subject><subject>Catheters</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Combined Modality Therapy</subject><subject>Complications and side effects</subject><subject>Constriction, Pathologic</subject><subject>Coronary vessels</subject><subject>Endovascular Procedures - adverse effects</subject><subject>Female</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypertension - diagnosis</subject><subject>Hypertension - drug therapy</subject><subject>Hypertension - physiopathology</subject><subject>Hypertension - surgery</subject><subject>Hypertension - therapy</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Medical schools</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mortality</subject><subject>Nephrology</subject><subject>Original Article</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Renal artery obstruction</subject><subject>Retrospective Studies</subject><subject>Risk factors</subject><subject>Syndrome</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Urology</subject><subject>Vascular Surgical Procedures - adverse effects</subject><subject>Veins & arteries</subject><subject>Young Adult</subject><issn>0931-041X</issn><issn>1432-198X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kt9r1EAQxxex2LP6B_giC4JPps7-Sja-laKtUPFFoS-ybDaT3JZk99xNqvffm-OqbeFkHgZmPt8ZmPkS8orBKQOo3mcAWVYFMFFwxWShn5AVk4IXrNbXT8kKasEKkOz6mDzP-QYAtNLlM3LMRVUpEHpFfnzxrY1p8o7mbWhTHPEDFUC3aFOmsaP4e4PJY3BIf_lpTUdsvbPDO4qhjbc2u3mwidrQ0jynfteiow22xxHD9IIcdXbI-PIun5Dvnz5-O78srr5efD4_uyqcUmwqZOegdS3njqPSoFkJZVk3DWtqEJLVFdpSN9Ap4KoRzHVVpyqUlittKwutOCFv9nM3Kf6cMU_mJs4pLCsNk7wSshSsvqd6O6DxoYtTsm702ZkzIQVTZc1goYoDVI8Bkx1iwM4v5Uf86QF-iRZH7w4K3j4QrNEO0zrHYZ58DPkxyPagSzHnhJ3ZJD_atDUMzM4AZm8AsxjA7Axg9KJ5fXeJuVle9U_x9-MLwPdAXlqhx_TgVP-d-gfNzLfv</recordid><startdate>20131001</startdate><enddate>20131001</enddate><creator>Porras, Diego</creator><creator>Stein, Deborah R.</creator><creator>Ferguson, Michael A.</creator><creator>Chaudry, Gulraiz</creator><creator>Alomari, Ahmad</creator><creator>Vakili, Khashayar</creator><creator>Fishman, Steven J.</creator><creator>Lock, James E.</creator><creator>Kim, Heung B.</creator><general>Springer Berlin Heidelberg</general><general>Springer</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope></search><sort><creationdate>20131001</creationdate><title>Midaortic syndrome: 30 years of experience with medical, endovascular and surgical management</title><author>Porras, Diego ; Stein, Deborah R. ; Ferguson, Michael A. ; Chaudry, Gulraiz ; Alomari, Ahmad ; Vakili, Khashayar ; Fishman, Steven J. ; Lock, James E. ; Kim, Heung B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c551t-4fc0dcd22c2e5808160669bb1b9034197ea68b0f5025b31cf7f57e4a258a7a0d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Age</topic><topic>Angioplasty</topic><topic>Antihypertensive Agents - adverse effects</topic><topic>Antihypertensive Agents - therapeutic use</topic><topic>Aorta, Abdominal - drug effects</topic><topic>Aorta, Abdominal - physiopathology</topic><topic>Aorta, Abdominal - surgery</topic><topic>Aortic Diseases - diagnosis</topic><topic>Aortic Diseases - drug therapy</topic><topic>Aortic Diseases - physiopathology</topic><topic>Aortic Diseases - surgery</topic><topic>Aortic Diseases - therapy</topic><topic>Arterial Occlusive Diseases - diagnosis</topic><topic>Arterial Occlusive Diseases - drug therapy</topic><topic>Arterial Occlusive Diseases - physiopathology</topic><topic>Arterial Occlusive Diseases - surgery</topic><topic>Arterial Occlusive Diseases - therapy</topic><topic>Arterial Pressure - drug effects</topic><topic>Blood pressure</topic><topic>Boston</topic><topic>Cardiology</topic><topic>Care and treatment</topic><topic>Catheters</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Combined Modality Therapy</topic><topic>Complications and side effects</topic><topic>Constriction, Pathologic</topic><topic>Coronary vessels</topic><topic>Endovascular Procedures - adverse effects</topic><topic>Female</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Hypertension - diagnosis</topic><topic>Hypertension - drug therapy</topic><topic>Hypertension - physiopathology</topic><topic>Hypertension - surgery</topic><topic>Hypertension - therapy</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Medical schools</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mortality</topic><topic>Nephrology</topic><topic>Original Article</topic><topic>Patient outcomes</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Renal artery obstruction</topic><topic>Retrospective Studies</topic><topic>Risk factors</topic><topic>Syndrome</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Urology</topic><topic>Vascular Surgical Procedures - adverse effects</topic><topic>Veins & arteries</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Porras, Diego</creatorcontrib><creatorcontrib>Stein, Deborah R.</creatorcontrib><creatorcontrib>Ferguson, Michael A.</creatorcontrib><creatorcontrib>Chaudry, Gulraiz</creatorcontrib><creatorcontrib>Alomari, Ahmad</creatorcontrib><creatorcontrib>Vakili, Khashayar</creatorcontrib><creatorcontrib>Fishman, Steven J.</creatorcontrib><creatorcontrib>Lock, James E.</creatorcontrib><creatorcontrib>Kim, Heung B.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><jtitle>Pediatric nephrology (Berlin, West)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Porras, Diego</au><au>Stein, Deborah R.</au><au>Ferguson, Michael A.</au><au>Chaudry, Gulraiz</au><au>Alomari, Ahmad</au><au>Vakili, Khashayar</au><au>Fishman, Steven J.</au><au>Lock, James E.</au><au>Kim, Heung B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Midaortic syndrome: 30 years of experience with medical, endovascular and surgical management</atitle><jtitle>Pediatric nephrology (Berlin, West)</jtitle><stitle>Pediatr Nephrol</stitle><addtitle>Pediatr Nephrol</addtitle><date>2013-10-01</date><risdate>2013</risdate><volume>28</volume><issue>10</issue><spage>2023</spage><epage>2033</epage><pages>2023-2033</pages><issn>0931-041X</issn><eissn>1432-198X</eissn><abstract>Background
Midaortic syndrome is often associated with refractory hypertension. The aim of our study was to better understand the short- and medium-term outcomes in this patient population utilizing a multidisciplinary management approach.
Methods
We conducted a review of patients with midaortic syndrome treated at our institution over the past 30 years.
Results
Fifty-three patients presented at a median age of 6.7 years (birth to 28.7 years). Thirty-five patients (66 %) underwent invasive management (percutaneous techniques: 21; surgical techniques: 5; both: 9). Percutaneous interventions were acutely successful in decreasing the gradient across the obstruction and degree of luminal stenosis. However, freedom from reintervention was 58 % at 1 year and 33 % at 5 years. Freedom from reintervention after a surgical procedure was longer: 83 % at 1 year and 72 % at 10 years. At the most recent follow-up, the majority of patients (69 %) were normotensive. The median duration between time of presentation and achievement of blood pressure control was 5.7 (0.4–21.1) years. The median number of anti-hypertensive medications was 1 (0–5).
Conclusions
A multidisciplinary management strategy which couples comprehensive medical management with catheter-based and surgical interventions can lead to adequate blood pressure control and preservation of end-organ function in patients with midaortic syndrome.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>23775038</pmid><doi>10.1007/s00467-013-2514-8</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Pediatric nephrology (Berlin, West), 2013-10, Vol.28 (10), p.2023-2033 |
| issn | 0931-041X 1432-198X |
| language | eng |
| recordid | cdi_proquest_journals_1427346319 |
| source | MEDLINE; SpringerLink Journals |
| subjects | Adolescent Adult Age Angioplasty Antihypertensive Agents - adverse effects Antihypertensive Agents - therapeutic use Aorta, Abdominal - drug effects Aorta, Abdominal - physiopathology Aorta, Abdominal - surgery Aortic Diseases - diagnosis Aortic Diseases - drug therapy Aortic Diseases - physiopathology Aortic Diseases - surgery Aortic Diseases - therapy Arterial Occlusive Diseases - diagnosis Arterial Occlusive Diseases - drug therapy Arterial Occlusive Diseases - physiopathology Arterial Occlusive Diseases - surgery Arterial Occlusive Diseases - therapy Arterial Pressure - drug effects Blood pressure Boston Cardiology Care and treatment Catheters Child Child, Preschool Combined Modality Therapy Complications and side effects Constriction, Pathologic Coronary vessels Endovascular Procedures - adverse effects Female Hospitals Humans Hypertension Hypertension - diagnosis Hypertension - drug therapy Hypertension - physiopathology Hypertension - surgery Hypertension - therapy Infant Infant, Newborn Kaplan-Meier Estimate Male Medical schools Medicine Medicine & Public Health Mortality Nephrology Original Article Patient outcomes Patients Pediatrics Renal artery obstruction Retrospective Studies Risk factors Syndrome Time Factors Treatment Outcome Urology Vascular Surgical Procedures - adverse effects Veins & arteries Young Adult |
| title | Midaortic syndrome: 30 years of experience with medical, endovascular and surgical management |
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