Multiple aneurysms in childhood - case report and review of the literature

Multiple Idiopathic Aneurysms in a 6-Year-Old Boy

We report the rare case of a young boy affected by idiopathic multiple aneurysms at different arterial locations who was treated at our institution with different surgical and endovascular techniques.

Pediatric nonaortic arterial aneurysms

OBJECTIVE

Pediatric arterial aneurysms are extremely uncommon. Indications for intervention remain poorly defined and treatments vary. The impetus for this study was to better define the contemporary surgical management of pediatric nonaortic arterial aneurysms.

METHODS

A retrospective analysis was conducted of 41 children with 61 aneurysms who underwent surgical treatment from 1983 to 2015 at the University of Michigan. Arteries affected included: renal (n = 26), femoral (n = 7), iliac (n = 7), superior mesenteric (n = 4), brachial (n = 3), carotid (n = 3), popliteal (n = 3), axillary (n = 2), celiac (n = 2), ulnar (n = 2), common hepatic (n = 1), and temporal (n = 1). Intracranial aneurysms and aortic aneurysms treated during the same time period were not included in this study. Primary outcomes analyzed were postoperative complications, mortality, and freedom from reintervention.

RESULTS

The study included 27 boys and 14 girls, with a median age of 9.8 years (range, 2 months-18 years) and a weight of 31.0 kg (range, 3.8-71 kg). Multiple aneurysms existed in 14 children. Obvious factors that contributed to aneurysmal formation included: proximal juxta-aneurysmal stenoses (n = 14), trauma (n = 12), Kawasaki disease (n = 4), Ehlers-Danlos type IV syndrome (n = 1), and infection (n = 1). Preoperative diagnoses were established using arteriography (n = 23), magnetic resonance angiography (n = 6), computed tomographic arteriography (n = 5), or ultrasonography (n = 7), and confirmed during surgery. Indications for surgery included risk of expansion and rupture, potential thrombosis or embolization of aneurysmal thrombus, local soft tissue and nerve compression, and secondary hypertension in the case of renal artery aneurysms. Primary surgical techniques included: aneurysm resection with reanastomsis, reimplantation, or angioplastic closure (n = 16), interposition (n = 10) or bypass grafts (n = 2), ligation (n = 9), plication (n = 8), endovascular occlusion (n = 3), and nephrectomy (n = 4) in cases of unreconstructable renal aneurysmal disease. Later secondary operations were required to treat stenoses at the site of the original aneurysm repairs (n = 2) and new aneurysmal development (n = 1). Postoperative follow-up averaged 47 months (range, 1-349 months). No major perioperative morbidity and no mortality was encountered in this experience.

CONCLUSIONS

Pediatric arterial aneurysms represent a complex disease that affects multiple vascular territories. Results of the current series suggest that individualized surgical treatment, ranging from simple ligations to major arterial reconstructions, was durable and can be undertaken with minimal risk.

Renovascular hypertension in an 8-year-old girl

Secondary hypertension is the most common form of hypertension in childhood, particularly in the young age group: parenchymal disease and lesions of the renal artery account for the majority of such cases. Renal artery aneurysms (RAA) are rare and are usually diagnosed by Doppler ultrasonography or angiography performed in the investigation of specific clinical symptoms. We report herein a case of severe arterial hypertension in an 8-year-old girl arising from a large saccular RAA. Intravenous antihypertensive drugs were necessary to achieve blood pressure control and the final diagnosis was obtained from angio-CT scan and selective angiography that demonstrated a large saccular aneurysm of the left renal artery with parietal calcification. After confirmation of inexistent function of the entire left kidney by Tc99m-MAG3 renal isotope scan, nephrectomy was performed. The child's blood pressure further normalised and, 1 month after surgery, she had ceased any antihypertensive therapy.

Congenital external carotid artery aneurysm

An 8-month-old child presented with a right pulsatile neck mass. The tumor's rapid increase in size and respiratory problems prompted image evaluation. An external carotid artery aneurysm was found, which was compressing other neck structures. The patient underwent aneurysm resection and ligation at its insertion on the common carotid artery. Recovery was uneventful and no further aneurysms on other arteries were found.

Idiopathic renal artery and infrarenal aortic aneurysms in a 6-year-old child: case report and literature review

Multiple arterial aneurysms are distinctly rare in the pediatric population. Most arterial aneurysms in children are secondary to infections, trauma, arteritides, collagen vascular diseases, and other causes. True idiopathic aneurysms are the least common and less than a dozen reports of multiple idiopathic aneurysms have been published. We present a case of an idiopathic, symptomatic renal artery aneurysm with fistulization to the renal vein and a concomitant abdominal aortic aneurysm in a 6-year-old boy. The diagnostic workup, surgical treatment, pathologic findings, and a review of the literature are presented.

Multiple aneurysms in childhood

Arterial aneurysms in children are rare. When present, they are often associated with connective tissue disorders or arteritidies. Idiopathic aneurysms occurring at multiple sites throughout the arterial tree are rare, with only ten cases reported. This report describes a case of multiple arterial aneurysms of uncertain origin involving upper-extremity, extracranial cerebrovascular, aortoiliac, and renal arteries in a 14-year-old boy. The clinical presentation, vascular reconstruction, pathologic findings, and a brief review of the literature are described.