Abstract
Mid‐aortic syndrome (MAS) is a rare condition marked by narrowing of the thoraco‐abdominal aorta, often causing severe hypertension. We present a 17‐year‐old male with refractory hypertension due to high‐grade aortic coarctation at the viscero‐renal segment. After failed endovascular interventions, open thoracoabdominal aortic repair was performed. The celiac trunk, superior mesenteric artery (SMA), and right renal artery were initially implanted into the tubegraft as a patch, but limited blood flow required revision including separate bypasses for the visceral arteries and both renal arteries. The patient was discharged with normalized blood pressure. Histopathology revealed adventitial necrosis, smooth muscle disorganization, and severe intimal thickening, suggesting intimal hyperplasia and fibrosis reduced blood flow. Separate bypasses might have been more effective than a patch for long‐term patency. At a 4‐year follow‐up, the patient remains stable, though the right renal bypass is occluded. This case report provides unique insights into the histopathological features of MAS and their potential impact on surgical decision‐making, contributing to our understanding of this rare condition.