Abdominal aortic aneurysm in a neonate

Open repair of a ruptured abdominal aorta with an aortoiliac vein fistula in a 7-month-old infant and review of the literature

Ruptured abdominal aortic aneurysms are extremely rare in the pediatric population. In this video case report, we describe the successful repair of a ruptured abdominal aortic aneurysm in a 7-month-old female infant.

Diagnosis and treatment of congenital abdominal aortic aneurysm: a systematic review of reported cases

Background

Congenital abdominal aortic aneurysm (AAA) is distinctly rare in infants and children and carries a high mortality rate. Our objective was to summarize the experience of the diagnosis and treatment in patients with congenital AAA.

Methods

Reported cases of congenital AAA published prior to November 8, 2014, were identified through PubMed, EMBASE, Web of Science, and reference lists. All selected cases were evaluated for main clinical characteristics.

Results

Twenty-six cases of congenital AAA were identified in the English language literature. Congenital AAA occurred primarily in children under three years old, but it was also found in young adults and fetuses. With regards to the localization, the great majority of congenital AAA was infrarenal AAA. The majority of the AAA patients lacked specific symptoms, and a painless pulsatile abdominal mass was the most common clinical presentation. The diagnosis of AAA was based on ultrasound scanning in twenty-five cases, multi-slice spiral computed tomography angiography (MSCTA) in sixteen cases, and magnetic resonance angiography (MRA) in nine cases. Histopathological analyses were available in seven cases. Seven patients received conservative management. Surgical treatment was performed in seventeen cases, and open repair with an artificial graft was the main surgical intervention. The mortality associated with congenital AAA was high (30.76%). Ruptured aneurysm and renal failure were the main causes of death.

Conclusions

Good outcomes can be achieved in children with early identification of congenital AAA and individualized surgical repair with grafts.

Extensive congenital abdominal aortic aneurysm and renovascular disease in the neonate

Primary congenital abdominal aortic aneurysm is an extremely rare entity, with only 15 patients reported in the literature. Options for repair are often limited secondary to branch vessel size and other anatomic limitations. We present a neonate diagnosed with an abdominal aortic aneurysm on prenatal ultrasound. A postpartum computed tomography angiogram revealed an extensive type IV thoracoabdominal aortic aneurysm extending to the aortic bifurcation and resulting in bilateral renal artery stenosis. The unique features of this patient and challenges in management are discussed.

Anatomical repair of a congenital aneurysm of the distal abdominal aorta in a newborn

Congenital (primary) neonatal abdominal aortic aneurysm (AAA) is an extremely rare truncular arterial abnormality among numerous congenital vascular malformations. Only seven cases have been reported as congenital origin in newborns. This report presents the case of a male infant in whom a 33-mm congenital AAA was diagnosed prenatally and was successfully treated 10 days after birth without exogenous graft material or aneurysmorrhaphy. Follow-up study at 39 months demonstrated excellent clinical, ultrasound scan, and computed tomography scan findings. Anatomic reconstruction with native vessels is the preferred surgical technique to ensure the child's potential for harmonious growth.

Primary congenital abdominal aortic aneurysm: a case report with perinatal serial follow-up imaging

Abdominal aortic aneurysms in neonates and infants are rare and are usually associated with infection, vasculitis, connective tissue disorder, or iatrogenic trauma such as umbilical catheterization. An idiopathic congenital abdominal aortic aneurysm is the least common category and there are few descriptions of the imaging features. We present the antenatal and postnatal imaging findings of an idiopathic congenital abdominal aortic aneurysm including the findings on US, MRI and CT.

Large neonatal thoracoabdominal aneurysm: case report and review of the literature

We present a neonate with a large saccular aneurysm of the thoracoabdominal aorta, extending from the intrathoracic aorta to the left common iliac artery. No underlying cause could be identified. Despite an early diagnosis, the aneurysm was deemed inoperable because of the lengthy involvement and the frail aspect of all visceral arteries. A review of the literature on congenital abdominal aortic aneurysm in infants was conducted. Eleven cases of live-born infants with a congenital abdominal aortic aneurysm have previously been published. None of them involved as large a part of the thoracic and abdominal aorta as the case presented here.

Complex vascular reconstruction of abdominal aorta and its branches in the pediatric population

BACKGROUND

Subdiaphragmatic aortic diseases in children are rare and form a heterogeneous group. The pediatric patient presents unique challenges because of their size, concerns about proper timing and conduit for repair, and anticipating expected growth.

METHODS

We performed a retrospective review of operations involving the abdominal aorta and called branches in children between January 2003 and April 2007, focusing on the details of preoperative evaluation, operative technique, and outcomes. The pertinent literature is reviewed.

RESULTS

Twenty-two children (age, 2 days to 17 years) were included. Mean follow-up was 28 months. Aneurysms were seen in 5 children; the remainder had stenotic disease. Aneurysms were typically asymptomatic and diagnosed incidentally, whereas stenotic lesions most commonly presented with hypertension (HTN). Fourteen complex vascular repairs were performed. All of the children with aneurysms underwent prompt surgery. The children with stenoses had operations for poorly controlled HTN, claudication, and/or mesenteric ischemia. Most patients with stenotic disease were treated medically for HTN and were followed closely while awaiting optimal size and availability of autogenous conduit for reconstruction. Cryopreserved allograft was used in 3 of the aneurysm operations. Dacron grafts were used to repair 5 aortic stenotic lesions. Renal and mesenteric revascularizations were performed with saphenous vein grafts. Pediatric, general, and transplant surgeons and nephrologic and cardiologic teams were integral to evaluation and management. No major operative complications occurred.

CONCLUSION

Proper management of pediatric aortic vascular disease requires a multidisciplinary approach. It is best to use autologous grafts whenever possible. Children with stenotic disease should be treated medically for hypertension until they are large enough for an autologous graft reconstruction. Children with aneurysmal disease are at risk for embolism and thrombosis and therefore usually treated immediately using artificial graft material, if necessary.

Use of Palmaz stents in a newborn with congenital aneurysms and coarctation of the abdominal aorta

Anomalies of the abdominal aorta are rare in the pediatric population limiting the reported knowledge base from which management decisions can be made. A 3-week-old male with congenital abdominal aortic coarctation and multiple aneurysms presented with malignant hypertension. We report the safe deployment of overlapping Palmaz stents using a 4-French catheter delivery system with significant relief of the coarctation gradient and restoration of adequate renal perfusion.

Aortoiliac reconstruction in infants and toddlers: replacement with decellularized branched pulmonary artery allograft

BACKGROUND

Aortic reconstruction in infants and small children has been reported with Dacron or polytef prosthetic material, hypogastric artery autograft, and saphenous vein autograft. In children, synthetic grafts are limited by a concern for late infection and a lack of potential growth. Available autogenous vessels have a limited length and diameter. Conventional allografts have not been durable. When the entire infrarenal aorta and aortoiliac bifurcation must be replaced, none of the historic options are optimal.

METHODS

We report 2 cases of infrarenal aorta and aortoiliac bifurcation reconstruction using a new generation of cryopreserved allograft now decellularized for decreased immunogenicity. The branched pulmonary artery allograft is particularly attractive for reconstruction of the aortic bifurcation.

RESULTS

The postoperative course in both cases was uncomplicated. Follow-up with serial abdominal duplex ultrasound has shown no evidence of graft stenosis or calcification at 29 and 32 months, respectively.

CONCLUSIONS

The use of commercially available, decellularized, and antigen-reduced allograft offers a nonsynthetic option for replacement of the pediatric abdominal aorta. We chose this novel approach in hopes of reducing the lifetime risk for graft infection and maintaining the potential for graft ingrowth by the child.

Congenital abdominal aortic aneurysm: a case report

Abdominal aortic aneurysm (AAA) is distinctly uncommon in infants and children, and usually results from infection, iatrogenic trauma, vasculitis, connective tissue disorder, or tuberous sclerosis. Congenital "primary" neonatal AAA is exceedingly rare. The few reported cases of repair of congenital AAA describe use of synthetic graft material or aneurysmorrhaphy. We report the first successful treatment of a known 6 cm congenital infrarenal AAA repaired with a 5 mm cryopreserved allograft in a 4-month-old infant girl. The graft was pretreated with an antigen reduction process (SynerGraft), which preliminary studies suggest may inhibit allograft degeneration. The postoperative course was unremarkable. Lower extremity pulses and results of duplex ultrasound flow studies remained excellent at 14-month follow-up. Panel reactive antibodies against class I alloantigens remain negative. The use of an antigen-reduced allograft provides an acceptable conduit, which potentially may decrease allograft degeneration and relative graft stenosis associated with growth of the child, but requires follow-up.

Congenital abdominal aortic aneurysm causing renovascular hypertension, cardiomyopathy, and death in a 19-day-old neonate

A full-term baby girl who was sent home day of life 2 was admitted to the hospital on day of life 7 for respiratory distress and poor feeding. The child was found to be hypertensive and in heart failure. Further workup led to the diagnosis of a suprarenal abdominal aortic aneurysm, but the infant had deteriorated clinically with heart failure, modest renal failure, renovascular hypertension, and no operative cure. The child died on day of life 20. Early diagnosis and prompt surgical resection are essential to managing this rare and lethal condition.

Congenital abdominal aortic aneurysm in the infant: case report and review of the literature

Congenital abdominal aortic aneurysms are a distinct entity from acquired aortic aneurysms. The authors present the case of a 6-week-old boy with a 6-cm aneurysm involving the abdominal aorta and common iliac arteries. Three other cases of congenital aortic aneurysms are reviewed, and an approach to these rare patients is discussed. J Pediatr Surg 36:657-658.

Clinicopathologic findings in congenital aneurysms of the great vessels

We describe the clinical, histopathologic, and angiographic findings in four children with congenital abnormalities of the great vessels of unknown cause, comprising either single or multiple arterial aneurysms, aortic/arterial dilatation, vessel tortuosity, or combinations of these abnormalities. Two children had early and severe respiratory distress due to aneurysmal compression of the trachea. All children had diffuse dilatation of several arteries, and two children also had tortuosity of multiple arteries. Progression of these abnormalities was clearly evident in one child, in whom diffuse vessel irregularity and tortuosity affected intra-abdominal, and intra and extra-cranial arteries. One child died at 5 years, while the other three have undergone successful surgical repair in the first 3 months of life and are now well, between age 2.5 and 7 years. The phenotype of each child appears unique but all have in common the rare finding of aneurysms of the aorta and main pulmonary artery. Congenital aortic aneurysms did not occur as an isolated finding in any of these children.

Thoracoabdominal aortic aneurysm in an infant treated by thromboexclusion with thoracoabdominal aortic bypass. A case report

A case of a huge thoracoabdominal aortic aneurysm in an eighteen-month-old boy is reported. Surgical treatment was successfully performed by thromboexclusion of the aneurysm with thoracoabdominal aortic bypass using a low-porosity woven Dacron graft 10 mm in diameter and of sufficient surplus length. During the early postoperative period, he developed moderate hydronephrosis, owing to compression of the left ureter by the graft, but no further deterioration was seen. Follow-up angiographies performed four and six years after surgery revealed straightening of the graft and slight stretching of the aorta at the distal anastomosis, but no stenosis was found. Now, seven and a half years after surgery, he has no pressure gradient between upper and lower extremities.