A 15-yr-old male with ischemic bowel pain and mid-aortic syndrome presented for surgical correction. An aortogram revealed narrowing of the aorta (black arrow) from the level of the celiac artery to the origin of the inferior mesenteric artery. Whereas the right renal artery (dotted arrow) branched off the narrowed segment of the aorta, the left kidney was supplied entirely from collateral vessels from the celiac axis (white arrows).

Mid-aortic syndrome is responsible for 0.5 to 2% of stenotic lesions of the aorta present in children and young adults. Up to 85% of patients have narrowing at a level that involves the renal arteries. This chronically compromises renal blood flow, which leads to worsening renovascular hypertension and kidney disease. Additionally, up to 70% of patients have superimposed unilateral or bilateral renal...

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