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

Abstract

Abstract Objective 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. Design and methods 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. Results 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. Conclusions 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.