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Fuson OI, Hirai K, Halleran DR, Jafri M, Muralidaran A, Azarbal A, Abraham CZ, Shalhub S. Open repair of a ruptured abdominal aorta with an aortoiliac vein fistula in a 7-month-old infant and review of the literature. J Vasc Surg Cases Innov Tech 2024; 10:101441. [PMID: 38464889 PMCID: PMC10921241 DOI: 10.1016/j.jvscit.2024.101441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/19/2024] [Indexed: 03/12/2024] Open
Abstract
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.
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Affiliation(s)
- Olivia I. Fuson
- Division of Vascular and Endovascular Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Kelsi Hirai
- Division of Vascular and Endovascular Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Devin R. Halleran
- Division of Pediatric Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Mubeen Jafri
- Division of Pediatric Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Ashok Muralidaran
- Division of Cardiac Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Amir Azarbal
- Division of Vascular and Endovascular Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Cherrie Z. Abraham
- Division of Vascular and Endovascular Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Sherene Shalhub
- Division of Vascular and Endovascular Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR
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2
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Le-Nguyen A, Joharifard S, Côté G, Borsuk D, Ghali R, Lallier M. Neonatal Microsurgical Repair of a Congenital Abdominal Aortic Aneurysm with a Cadaveric Graft. European J Pediatr Surg Rep 2021; 9:e23-e27. [PMID: 33680709 PMCID: PMC7929720 DOI: 10.1055/s-0041-1723019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/18/2020] [Indexed: 10/28/2022] Open
Abstract
Congenital abdominal aortic aneurysms (AAA) are an extremely rare entity. We present the case of a female fetus diagnosed with an AAA on routine prenatal ultrasound. A postnatal computed tomography angiogram revealed an infrarenal AAA with a narrow proximal neck. Surgery was performed on day of life 14 using a cadaveric femoral artery graft. The proximal anastomosis was performed under the microscope given the severity of the aortic stenosis and the proximity of the renal arteries. The patient's postoperative course was uneventful and she is developing normally 1 year after surgery. The graft remains permeable, albeit with evidence of proximal and distal stenosis and graft calcification on imaging.
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Affiliation(s)
- Annie Le-Nguyen
- Department of Surgery, Division of General Surgery, Saint Justine Hospital, Montreal, Quebec, Canada
| | - Shahrzad Joharifard
- Department of Surgery, Division of Pediatric Surgery, Saint Justine Hospital, Montreal, Quebec, Canada
| | - Geneviève Côté
- Department of Anesthesiology, Saint Justine Hospital, Montreal, Quebec, Canada
| | - Daniel Borsuk
- Department of Surgery, Division of Plastic Surgery, Saint Justine Hospital, Montreal, Quebec, Canada
| | - Rafik Ghali
- Department of Surgery, Division of Vascular Surgery, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Michel Lallier
- Department of Surgery, Division of Pediatric Surgery, Saint Justine Hospital, Montreal, Quebec, Canada
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3
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Tanga CF, Fakhoury E, Ham PB, Dosluoglu HH, Harris LM. Ruptured abdominal aortic aneurysm in an 11-year-old with multiple peripheral artery aneurysms. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:539-542. [PMID: 33134637 PMCID: PMC7588751 DOI: 10.1016/j.jvscit.2020.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/23/2020] [Indexed: 11/25/2022]
Abstract
Pediatric abdominal aortic aneurysms (AAAs) are rarely encountered in clinical practice. The combination of a pediatric AAA in a patient with multiple peripheral artery aneurysms is even more rare. We report the management of an 11-year-old boy who presented with a ruptured AAA who also had multiple peripheral arterial aneurysms. Infectious, genetic, and inflammatory workup was negative, classifying this aneurysm as congenital.
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Affiliation(s)
| | - Elias Fakhoury
- Department of Vascular Surgery, University at Buffalo, Buffalo, NY
| | - P Benson Ham
- Department of Vascular Surgery, University at Buffalo, Buffalo, NY
| | | | - Linda M Harris
- Department of Vascular Surgery, University at Buffalo, Buffalo, NY
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4
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Concomitant presentation and surgical management of an abdominal aortic aneurysm and translocation XP11.2 associated renal cell carcinoma in a female infant. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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5
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Eliason JL, Coleman DM, Criado E, Stanley JC. Surgical treatment of abdominal aortic aneurysms in infancy and early childhood. J Vasc Surg 2016; 64:1252-1261. [DOI: 10.1016/j.jvs.2016.04.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/14/2016] [Indexed: 10/21/2022]
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6
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Wang Y, Tao Y. Diagnosis and treatment of congenital abdominal aortic aneurysm: a systematic review of reported cases. Orphanet J Rare Dis 2015; 10:4. [PMID: 25608574 PMCID: PMC4307982 DOI: 10.1186/s13023-015-0225-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 01/08/2015] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Yamei Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No.20, Section 3, Renmin Nan Lu, Chengdu, Sichuan Province, 610041, China. .,Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry Education, West China Second University Hospital, Sichuan University, Sichuan, China.
| | - Yuhong Tao
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No.20, Section 3, Renmin Nan Lu, Chengdu, Sichuan Province, 610041, China.
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7
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Prenatal diagnosis and postnatal course of a giant abdominal aortic aneurysm: a case report. CASE REPORTS IN PERINATAL MEDICINE 2014. [DOI: 10.1515/crpm-2013-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Congenital abdominal aortic aneurysms are rare but have chronic and life-threatening sequelae including hypertension, thromboses, and death. A fetal ultrasound at 27 weeks’ gestation diagnosed a giant abdominal aortic aneurysm. The patient delivered at another tertiary care center where pediatric cardiovascular surgery care was available. Her term 3096-g female infant developed hypertension, biventricular hypertrophy, and right kidney ischemia. She underwent surgical repair at 2 months of life but subsequently lost all residual renal function and was not a candidate for dialysis. Support was withdrawn and she expired. Although isolated fetal AAA is rare, prenatal diagnosis is feasible and facilitates early referral for multi-disciplinary postnatal care. Outcome depends on the size and location of the aneurysm as well as on peri-operative complications.
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Bivins HA, Butler ES, Foster TL, Pyle R, Sumners JE. Congenital abdominal aortic aneurysm. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:233-234. [PMID: 24105685 DOI: 10.1002/uog.13209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 09/04/2013] [Accepted: 09/06/2013] [Indexed: 06/02/2023]
Affiliation(s)
- H A Bivins
- Center for Prenatal Diagnosis, Indianapolis, IN, USA
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Cho YP, Kim SC, Kim SA, Jun H, Kwon TW. An idiopathic congenital abdominal aortic aneurysm with impending rupture in a 23-month-old boy. J Vasc Surg 2012; 57:508-10. [PMID: 23219516 DOI: 10.1016/j.jvs.2012.08.106] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 08/17/2012] [Accepted: 08/18/2012] [Indexed: 11/30/2022]
Abstract
Abdominal aortic aneurysms are distinctly uncommon in infants and children. These aneurysms, which are idiopathic in nature without any definite predisposing factors, are exceedingly rare. We present the case of a giant idiopathic congenital infrarenal abdominal aortic aneurysm with impending rupture in a 23-month-old boy, which was successfully treated with surgical repair using a cryopreserved cadaveric allograft. To the best of our knowledge, this is the oldest case and the third successful treatment of an idiopathic congenital abdominal aortic aneurysm repaired with a cryopreserved allograft in infants and children. Continued follow-up with multimodality imaging is required.
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Affiliation(s)
- Yong-Pil Cho
- Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
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10
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McAteer J, Ricca R, Johansen KH, Goldin AB. Extensive congenital abdominal aortic aneurysm and renovascular disease in the neonate. J Vasc Surg 2012; 55:1762-5. [PMID: 22503182 DOI: 10.1016/j.jvs.2011.12.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 12/15/2011] [Accepted: 12/15/2011] [Indexed: 10/28/2022]
Abstract
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.
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Affiliation(s)
- Jarod McAteer
- Department of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA 98105, USA.
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11
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Tsunematsu R, Shinozaki T, Fukushima K, Yumoto Y, Hidaka N, Morokuma S, Fujita Y, Hojo S, Wake N. Congenital Abdominal Aortic Aneurysm with Porencephaly: A Case Report. Fetal Diagn Ther 2011; 29:248-52. [DOI: 10.1159/000322403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 10/25/2010] [Indexed: 11/19/2022]
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12
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Malikov S, Delarue A, Fais PO, Keshelava G. Anatomical repair of a congenital aneurysm of the distal abdominal aorta in a newborn. J Vasc Surg 2009; 50:1181-4. [PMID: 19595534 DOI: 10.1016/j.jvs.2009.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2008] [Revised: 05/11/2009] [Accepted: 05/12/2009] [Indexed: 10/20/2022]
Abstract
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.
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Affiliation(s)
- Sergueï Malikov
- Department of Vascular Surgery, School of Medicine, Mediterranean University, La Timone Hospital, Marseille Cedex, France.
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Callahan J, Drolshagen L, Cole A, Duncan N. Congenital Abdominal Aortic Aneurysm and Hypertrophic Pyloric Stenosis in an Infant. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2009. [DOI: 10.1177/8756479309340915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Infantile abdominal aortic aneurysms are rare, usually detected incidentally, and associated with connective tissue disease or due to iatrogenic causes. The diagnosis should be considered when a large cystic mass (especially pulsatile) is found in a neonate and confirmed using color and duplex sonography. Undiagnosed aneurysms have a high mortality rate. Surgical treatment is warranted when the patient is stabilized and may result in a normal outcome, although future graft replacement may be necessary.
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Affiliation(s)
| | | | - Alisa Cole
- University of Arkansas-Fort Smith and St Edward
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14
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Primary congenital abdominal aortic aneurysm: a case report with perinatal serial follow-up imaging. Pediatr Radiol 2008; 38:1249-52. [PMID: 18679609 DOI: 10.1007/s00247-008-0956-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2008] [Revised: 06/23/2008] [Accepted: 06/30/2008] [Indexed: 10/21/2022]
Abstract
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.
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15
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Buddingh KT, Zeebregts CJ, Tilanus MEC, Roofthooft MTR, Broens PMA. Large neonatal thoracoabdominal aneurysm: case report and review of the literature. J Pediatr Surg 2008; 43:1361-4. [PMID: 18639697 DOI: 10.1016/j.jpedsurg.2008.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Revised: 01/31/2008] [Accepted: 02/05/2008] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- K Tim Buddingh
- Division of Paediatric Surgery, Department of Surgery, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
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Kaye AJ, Slemp AE, Chang B, Mattei P, Fairman R, Velazquez OC. Complex vascular reconstruction of abdominal aorta and its branches in the pediatric population. J Pediatr Surg 2008; 43:1082-8. [PMID: 18558187 DOI: 10.1016/j.jpedsurg.2008.02.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Accepted: 02/09/2008] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Adam J Kaye
- Department of General Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
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17
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Affiliation(s)
- Shawn D St Peter
- Department of Pediatric Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA
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18
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Ballweg J, Liniger R, Rocchini A, Gajarski R. Use of Palmaz stents in a newborn with congenital aneurysms and coarctation of the abdominal aorta. Catheter Cardiovasc Interv 2006; 68:648-52. [PMID: 16969858 DOI: 10.1002/ccd.20749] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- J Ballweg
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
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19
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Martínez-Martínez L, Riera-De Cubas L, Ávila-Ramírez L, Riera-Del Moral L, Stefanov-Kiuri S, Gutiérrez-Nistal M, Jaureguízar-Monereo E, Tovar-Larrucea J. Aneurisma idiopático de aorta abdominal en una paciente de 8 años de edad. ANGIOLOGIA 2006. [DOI: 10.1016/s0003-3170(06)74975-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Meyers RL, Lowichik A, Kraiss LW, Hawkins JA. Aortoiliac reconstruction in infants and toddlers: replacement with decellularized branched pulmonary artery allograft. J Pediatr Surg 2006; 41:226-9. [PMID: 16410138 DOI: 10.1016/j.jpedsurg.2005.10.086] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Rebecka L Meyers
- Pediatric Surgery, Primary Children's Medical Center, Salt Lake City, UT 84113, USA.
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Abstract
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.
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Affiliation(s)
- Patrick Bell
- Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma 73190, USA
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