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Tissue expander-stimulated lengthening of arteries for the treatment of midaortic syndrome in children.

Abstract：

BACKGROUND:Midaortic syndrome (MAS) is a rare condition characterized by stenosis of the abdominal aorta. Patients with disease refractory to medical management will usually require either endovascular therapy or surgery with use of prosthetic graft material for bypass or patch angioplasty. We report our early experience with a novel approach using a tissue expander (TE) to lengthen the normal native arteries in children with MAS, allowing primary aortic repair without the need for prosthetic graft material. METHODS:We conducted a retrospective review of patients with MAS undergoing the TE-stimulated lengthening of arteries (TESLA) procedure at our institution from 2010 to 2014. Data are presented as mean (range). RESULTS:Five patients aged 4.8 years (3-8 years) underwent the TESLA procedure. Stages of this procedure include the following: stage I, insertion of retroaortic TE; stage II, serial TE injections; and stage III, final repair with excision of aortic stenosis and primary end-to-end aortic anastomosis. Stage II was completed in 4 months (1-9 months) with 12 (7-20) TE injections. Goal lengthening was achieved in all patients. Stage III could not be completed in one patient because of extreme aortic inflammation, which precluded safe excision of the aortic stenosis and required use of a prosthetic bypass graft. The other four patients completed stage III with two (one to three) additional vessels also requiring reconstruction (renal or mesenteric arteries). At 3.2 years (1-6 years) of follow-up, all patients are doing well. CONCLUSIONS:The TESLA procedure allows surgical correction of MAS without the need for prosthetic grafts in young children who are still growing.

journal_name

J Vasc Surg

journal_title

Journal of vascular surgery

authors

Kim HB,Vakili K,Ramos-Gonzalez GJ,Stein DR,Ferguson MA,Porras D,Lock JE,Chaudry G,Alomari A,Fishman SJ

doi

10.1016/j.jvs.2017.09.052

subject

Has Abstract

pub_date

2018-06-01 00:00:00

pages

1664-1672

issue

6

eissn

0741-5214

issn

1097-6809

pii

S0741-5214(17)32558-2

journal_volume

67

pub_type

杂志文章

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