Poster No. 111 Therapeutic Options and Outcomes in Mid Aortic Syndrome A systematic review and meta-analysis

Mid-Aortic Syndrome (MAS) is narrowing of the distal thoracic and/or abdominal aorta with congenital, inflammatory or idiopathic aetiology. If untreated, prognosis is poor due to hypertensive complications yet follow-up data are sparse. The aim of this study was to investigate hypertension during follow-up after medical, endovascular, and surgical therapy.

A meta-analysis of case series and reports, focusing on the incidence of hypertension during the follow-up of juvenile (0–17 years) and adult MAS patients after medical, endovascular or surgical therapy. Search queries were performed in PubMed, Embase, and Web of Science; eligible articles underwent quality control. Descriptive statistics were reported based on available data, individual patient data meta-analyses were performed using a one-stage approach, accounting for clustering by case series or decades of reporting for case reports. For the meta-analysis, missing outcome and aetiology data were multiply imputed.

The number of juveniles and adults who underwent endovascular therapy (33.7% versus 27.3%; P = .42) and surgery (52.2% versus 58.0%; P = .46) was similar. At baseline, 92.4% of juveniles and 87.5% of adults were hypertensive, decreasing to 23.2% and 24.1% during a follow-up of 23 (juveniles) and 18 (adults) months. In juveniles, after endovascular therapy more hypertension was found compared to surgery (38.1% versus 10.8%; P = .020). Meta-analysis demonstrated a trend for hypertension after endovascular therapy in juveniles, whereas hypertension was more prevalent following surgery in adults compared to endovascular therapy or medication.

Complications and hypertension in MAS during follow-up were more common in juveniles after endovascular treatment, whereas surgery in adults was associated with more hypertension.