Mesenteric Artery Growth Improves Circulation (MAGIC) in Midaortic Syndrome

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Midaortic syndrome (MAS) is a rare condition primarily affecting children and young adults, and is characterized by narrowing of the thoracic and/or abdominal aorta with frequent involvement of the renal and visceral arteries.1 The management of MAS initially involves a combination of medical and endovascular interventions to manage renovascular hypertension (HTN), claudication, and/or intestinal angina.2,3 Patients with refractory disease may eventually require surgery, typically a bypass procedure or a patch aortoplasty using a prosthetic graft.4–8 While effective at correcting the anatomic abnormality, the use of prosthetic grafts in children can lead to the need for additional procedures with somatic growth in addition to the standard complications associated with grafts including thrombosis, infection, and anastomotic aneurysm formation.9 We have previously reported a novel procedure in which a tissue expander was used to lengthen the normal distal aorta in a small child to replace the stenotic aorta without the need for a prosthetic graft.10 However, this technique cannot be used in cases of long segment aortic narrowing. Due to this limitation, our group has developed an alternative novel approach, which allows for a single-stage aortic bypass using the meandering mesenteric artery (MMA) in which mesenteric artery growth improves circulation (MAGIC) in select children with MAS. In this report, we present the first 2 cases of MAGIC to treat children with MAS.
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