LAUSR

A 54-year-old man with a history of hypertension had an abnormal finding on chest X ray and was referred to our hospital. He had been taking oral antihypertensive drugs since the age of 25. The blood test showed normal serum renal function (estimated glomerular filtration rate 1⁄4 65 mL/min/1.73 m), and the ankle brachial pressure index was 0.74 in both lower extremities. A three-dimensional volumerendered computed tomography (CT) revealed marked stenosis of the lower descending aorta with extensive collateral vessels (Figure A/cover). CT also showed saccular aneurysms in the distal site of the stenosis, and the celiacomesenteric trunk arose above the diaphragm (B). The patient was diagnosed with midaortic syndrome (MAS) with saccular aneurysms; therefore, an open surgery was performed. Operative findings revealed that the stenosis was very hardened and adhered to the surrounding area, whereas the aneurysm was extremely fragile (C). We performed graft replacement with revascularization of the common celiacomesenteric trunk via left thoracotomy under partial cardiopulmonary bypass. A postoperative CT angiogram showed patent aortic and the common celiacomesenteric trunk bypass grafts. The patient was discharged on postoperative day 16. Pathological examination revealed severe atherosclerotic degeneration in the stenosis and a lack of medial smoothmuscle in the aneurysm. The patient provided his informed consent for the publication of the details and images related to this report.