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Chamseddin K, Solano A, Keller MR, Siah MC, Gonzalez-Guardiola G, Prakash V, Shih M, Baig MS, Timaran CH, Kirkwood ML. Open repair of an abdominal aortic and right common iliac artery aneurysm with idiopathic retroperitoneal fibrosis in a 19-month-old infant. J Vasc Surg Cases Innov Tech 2024; 10:101513. [PMID: 38868166 PMCID: PMC11167345 DOI: 10.1016/j.jvscit.2024.101513] [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: 01/26/2024] [Accepted: 04/09/2024] [Indexed: 06/14/2024] Open
Abstract
An abdominal aortic aneurysm (AAA) in children is a rare clinical condition, with idiopathic AAAs even more atypical. We report a case of a 19-month-old girl with incidental findings of an infrarenal AAA and right common iliac artery aneurysm during workup for heart failure. Extensive genetic testing was unremarkable for connective tissue disorders. An aortic bi-iliac artery bypass with a Dacron graft from the infrarenal aorta to the right external iliac artery and left common iliac artery was performed. The patient achieved complete recovery and only required one oral hypertensive medication at 30 days of follow-up. Wide patency of the graft was observed on the 3-month follow-up computed tomography angiogram.
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Affiliation(s)
- Khalil Chamseddin
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Antonio Solano
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Melissa R. Keller
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael C. Siah
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Gerardo Gonzalez-Guardiola
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Vivek Prakash
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael Shih
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - M. Shadman Baig
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Carlos H. Timaran
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Melissa L. Kirkwood
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
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2
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Gomes VC, Parodi FE, Wood JC, Motta F, Farber MA. Rare Case of Abdominal Aortic and Multiple Visceral Aneurysms in a Pediatric Patient With PIK3CA Mutation and Vasculitis. Vasc Endovascular Surg 2024; 58:387-391. [PMID: 37944162 PMCID: PMC10996289 DOI: 10.1177/15385744231215561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Abdominal aortic aneurysms (AAA) are most commonly observed in elderly male patients and are particularly rare in children. Among the pediatric population, they are usually diagnosed in the context of connective tissue disorders, genetic mutations, or vasculitis. The same is true of visceral arteries aneurysms. This case report describes the staged management of an 11-year-old patient presenting PIK3CA mutation and a 5.8 cm infrarenal AAA associated with bilateral common iliac arteries and multiple visceral aneurysms, the largest observed in the superior mesenteric artery (SMA = 3.2 cm). After careful evaluation, decision was made to first approach the most life-threatening lesion (the infrarenal AAA due to the large diameter) and the remaining aneurysms in secondary procedures, with special attention to the SMA aneurysm. The patient underwent a staged repair, with the first phase consisting of an aortobi-iliac graft with the distal anastomosis made at the left common iliac artery and right external iliac artery. The right hypogastric artery was ligated. The second procedure consisted of SMA aneurysm repair with a plication technique, as 7 branches were visualized coming off the aneurysm sac. Postoperative pathology analysis of the aortic and SMA aneurysms sac revealed vasculitis with a mixed inflammatory pattern and a COL3A1 gene heterozygote variant. He is currently in his 18th month after the last surgical intervention, receiving immunomodulatory therapy, with a planned follow-up by the interdisciplinary team to monitor the medications' side effects and the diameter of the remaining visceral aneurysms.
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Affiliation(s)
- Vivian Carla Gomes
- Vascular Surgery Division, Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Federico Ezequiel Parodi
- Vascular Surgery Division, Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Jacob C Wood
- Vascular Surgery Division, Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Fernando Motta
- Vascular Surgery Division, Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Mark A Farber
- Vascular Surgery Division, Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
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3
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Jawad A, Hannouneh ZA, Soqia J, Al Nahhas Z, Ahmed A, Nahas MA. Rare giant renal artery aneurysm in neurofibromatosis type 1 patient: a case report. Ann Med Surg (Lond) 2023; 85:5748-5751. [PMID: 37915684 PMCID: PMC10617891 DOI: 10.1097/ms9.0000000000001329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 09/10/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction and importance Neurofibromatosis type 1 (NF1) is a genetic disorder characterised by multiple neurofibromas, café-au-lait spots, and iris hamartomas. The variety of vasculopathies that can occur in NF1 make it difficult for clinicians to accurately follow-up patients. Most cases of vasculopathies are stenotic, and, in few cases, aneurysms may form. Case presentation A 35-year-old male presented with extreme left flank pain for the past 2 days. His physical examination revealed whole-body several café-au-lait skin macules, a subcutaneous lesion, and a palpable abdominal mass in the left flank. His laboratory workup was within normal ranges. A multi-slice computed tomography and computed tomography angiogram with contrast outlined a giant left renal artery aneurysm (RAA). A kidney salvage surgery was planned. However, due to ectatic dilatation and large extension of the aneurysm, the affected renal artery branches and renal vein were found unfit for auto-transplantation during the surgical procedure and a total nephrectomy was necessary. Symptoms improved significantly postoperatively and no complications developed. Clinical discussion RAA is an uncommon finding in NF1 patients. Diagnosis is often dependent on computed tomography angiogram. Management techniques are conservative, endovascular, or surgical. In few surgical cases, a total nephrectomy may be necessary if auto-transplantation is not feasible. Conclusion Despite its rarity, the diagnosis of RAA should be considered in patients with NF1 presenting with flank pain. Moreover, early screening for renal vasculopathies can evade critical surgical outcomes including a total nephrectomy. Hence, the authors recommend a total vascular workup for these patients, consisting of doppler ultrasound and, if necessary, a multi-slice computed tomography with contrast.
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Affiliation(s)
- Ali Jawad
- Faculty of Medicine, Damascus University
| | - Zein Alabdin Hannouneh
- Faculty of Medicine, Al Andalus University for Medical Sciences, Tartus, Syrian Arab Republic
| | | | | | | | - Mohamad Ali Nahas
- Head of Vascular and Endovascular Surgery Division, Al-Assad University Hospital, Damascus University
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4
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Alfayez AA, Neazy SA, Batheeb NA, Aljaber FK, AlMutairi SS, Asiri A. Acquired Saccular Abdominal Aortic Aneurysm in a 10-Year-Old Child: A Case Report and Literature Review. Cureus 2023; 15:e46914. [PMID: 37841981 PMCID: PMC10569742 DOI: 10.7759/cureus.46914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 10/17/2023] Open
Abstract
An abdominal aortic aneurysm (AAA) is a confined dilatation involving the abdominal aorta. The incidence is rare and the etiology is unknown. Cases associated with conditions like Kawasaki, connective tissue, Behcet's diseases, and vasculitis are considered acquired. Our patient had a clinical criterion of Behcet's disease. Management involves a surgical approach. Endovascular intervention is not an option here, as the aneurysm is close to the bifurcation evident in computed tomography angiogram scans. Usually, they have good long-term outcomes. In our paper, we aim to describe the clinical presentation, management approach, and the outcome of our patient with an acquired AAA.
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Affiliation(s)
- Adel A Alfayez
- Department of Pediatric Surgery, Prince Sultan Military Medical City, Riyadh, SAU
| | - Sultan A Neazy
- Department of Pediatric Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | - Nabil A Batheeb
- Department of Vascular Surgery, Prince Sultan Military Medical City, Riyadh, SAU
| | - Fahad K Aljaber
- Department of Vascular Surgery, Prince Sultan Military Medical City, Riyadh, SAU
| | - Sajdi S AlMutairi
- Department of Pediatrics Rheumatology, King Saud University Medical City, Riyadh, SAU
| | - Abdulrahman Asiri
- Department of Pediatrics Rheumatology, Prince Sultan Military Medical City, Riyadh, SAU
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5
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Huerta CT, Quinn K, Restrepo R, Mas M, Patel B, Melnick SJ, Sola JE, Velazquez OC, Thorson CM. Peripheral vascular bypass with cadaveric arterial allograft in a toddler with femoral mycotic aneurysm. J Surg Case Rep 2023; 2023:rjad198. [PMID: 37114089 PMCID: PMC10125839 DOI: 10.1093/jscr/rjad198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
Mycotic aneurysms are exceedingly rare in the pediatric population. The optimal surgical treatment for children with this disease is unclear as aneurysm resection and vascular reconstruction are uncommonly performed in young children. We present a unique case of a 21-month-old child with a complex cardiac history who presented with limb ischemia and was discovered to have thrombosis of the common femoral and superficial femoral artery. Groin exploration revealed a left common femoral and superficial femoral artery mycotic aneurysm that was successfully repaired with excision of the mycotic aneurysm, external iliac to profunda femoral artery vascular bypass using cryopreserved arterial allograft and femoral vein reconstruction. This case demonstrates successful vascular reconstruction can be performed in a young child with an Aspergillus mycotic aneurysm using cadaveric arterial allograft.
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Affiliation(s)
- Carlos Theodore Huerta
- Dewitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kirby Quinn
- Dewitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ricardo Restrepo
- Pediatric Specialists of America, Pediatric Interventional Radiology, Nicklaus Children’s Hospital, Miami, FL, USA
| | - Madeleen Mas
- Pediatrix Medical Group, Pediatric Cardiology, Miami, FL, USA
| | - Bhavi Patel
- Pediatric Specialists of America, Cardiac Critical Care, Nicklaus Children’s Hospital, Miami, FL, USA
| | - Steven J Melnick
- Department of Pathology, Nicklaus Children’s Hospital, Miami, FL, USA
| | - Juan E Sola
- Dewitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Omaida C Velazquez
- Dewitt-Daughtry Family Department of Surgery, Division of Vascular Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chad M Thorson
- Correspondence address. Dewitt-Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, P.O. Box 016960 (R-51), Miami, FL, USA. Tel: (305) 243-2247; Fax: 1 (305) 243-5731; E-mail:
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6
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Schirwani S, Woods E, Koolen DA, Ockeloen CW, Lynch SA, Kavanagh K, Graham JM, Grand K, Pierson TM, Chung JM, Balasubramanian M. Familial Bainbridge-Ropers syndrome: Report of familial ASXL3 inheritance and a milder phenotype. Am J Med Genet A 2023; 191:29-36. [PMID: 36177608 PMCID: PMC10087684 DOI: 10.1002/ajmg.a.62981] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/22/2022] [Accepted: 09/08/2022] [Indexed: 12/14/2022]
Abstract
De novo truncating and splicing pathogenic variants in the Additional Sex Combs-Like 3 (ASXL3) gene are known to cause neurodevelopmental delay, intellectual disability, behavioral difficulties, hypotonia, feeding problems and characteristic facial features. We previously reported 45 patients with ASXL3-related disorder including three individuals with a familial variant. Here we report the detailed clinical and molecular characteristics of these three families with inherited ASXL3-related disorder. First, a father and son with c.2791_2792del p.Gln931fs pathogenic variant. The second, a mother, daughter and son with c.4534C > T, p.Gln1512Ter pathogenic variant. The third, a mother and her daughter with c.4441dup, p.Leu1481fs maternally inherited pathogenic variant. This report demonstrates intrafamilial phenotypic heterogeneity and confirms heritability of ASXL3-related disorder.
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Affiliation(s)
- Schaida Schirwani
- Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK.,Sheffield Clinical Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Emily Woods
- Sheffield Clinical Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - David A Koolen
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Charlotte W Ockeloen
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Sally Ann Lynch
- Department of Clinical Genetics, Children's Health Ireland, Dublin, Ireland
| | - Karl Kavanagh
- Department of Clinical Genetics, Children's Health Ireland, Dublin, Ireland
| | - John M Graham
- Division of Medical Genetics, Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Katheryn Grand
- Division of Medical Genetics, Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Tyler Mark Pierson
- Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Cedars-Sinai Center for the Undiagnosed Patient, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jeffrey M Chung
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Meena Balasubramanian
- Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK.,Sheffield Clinical Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
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7
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Marra P, Di Fazio B, Dulcetta L, Carbone FS, Muglia R, Bonaffini PA, Valle C, Corvino F, Giurazza F, Muscogiuri G, Venturini M, Sironi S. Embolization in Pediatric Patients: A Comprehensive Review of Indications, Procedures, and Clinical Outcomes. J Clin Med 2022; 11:jcm11226626. [PMID: 36431102 PMCID: PMC9696500 DOI: 10.3390/jcm11226626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 11/10/2022] Open
Abstract
Embolization in pediatric patients encompasses a large spectrum of indications, ranging from the elective treatment of congenital diseases of the cardiovascular system to the urgent management of acute hemorrhagic conditions. In particular, the endovascular treatment of central and peripheral vascular malformations and hypervascular tumors represents a wide chapter for both congenital and acquired situations. Thanks to the progressive availability of low-profile endovascular devices and new embolic materials, the mini-invasive approach has gradually overtaken surgery. In this review, the main embolization procedures will be illustrated and discussed, with a focus on clinical indications and expected outcomes. The most recent mini-invasive techniques will be described, with hints on the cutting-edge devices and embolic materials.
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Affiliation(s)
- Paolo Marra
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Barbaro Di Fazio
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
- Correspondence: ; Tel.: +39-347-516-5851 or +39-035-267-4359
| | - Ludovico Dulcetta
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Francesco Saverio Carbone
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Riccardo Muglia
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
| | - Pietro Andrea Bonaffini
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Clarissa Valle
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Fabio Corvino
- Department of Vascular and Interventional Radiology, Cardarelli Hospital, 80131 Naples, Italy
| | - Francesco Giurazza
- Department of Vascular and Interventional Radiology, Cardarelli Hospital, 80131 Naples, Italy
| | - Giuseppe Muscogiuri
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Radiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, 20149 Milan, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, Insubria University, 21100 Varese, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
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8
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Yang XZ, Li PY, Zhang BH, Yan ZG, Niu GC, Yang M. Contrast-enhanced magnetic resonance angiography for monitoring an embolized renal artery aneurysm: A case report and literature review. J Int Med Res 2022; 50:3000605221136711. [DOI: 10.1177/03000605221136711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This case report describes a 69-year-old male patient with a renal artery aneurysm that was followed up with contrast-enhanced magnetic resonance angiography at 8 months after coil embolization treatment. Due to the disappearance of residual lumen with few metal artifacts, the therapeutic effect was satisfactory. At present, the indications for the treatment of renal artery aneurysms are still controversial and there are very few reports of postembolization images of renal artery aneurysms, with no criteria for reintervention and few reports for monitoring the embolized aneurysms. Further reports and research are still needed for the treatment of this rare disease.
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Affiliation(s)
- Xin-Zhi Yang
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Peng-Yu Li
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Bi-Hui Zhang
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Zi-Guang Yan
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Guo-Chen Niu
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Min Yang
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
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9
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Al Laham O, Shahrour A, Yahya O, Hamzeh H. Successful surgical repair of an eminently rare case of an incidental idiopathic Common Femoral Artery Pseudoaneurysm in a 6-year-old female child - A Case Report. Int J Surg Case Rep 2022; 96:107362. [PMID: 35777337 PMCID: PMC9284049 DOI: 10.1016/j.ijscr.2022.107362] [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: 05/22/2022] [Revised: 06/09/2022] [Accepted: 06/24/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE A Pseudoaneurysm is an abnormal outpouching of the arterial wall which progressively enlarges and could lead to catastrophic consequences. Ensuing damage could culminate in the loss of the affected extremity due to dissection, exsanguination, thromboembolism, or infection. Some presentations are symptomatic, whereas others are incidental findings. Timely surgical mediation is vital to eliminate the potential morbid sequelae. CASE PRESENTATION We present the case of a 6-year-old female, who was referred to the clinic due to an incidental finding of a pulsatile bulge in her right groin. We confirmed the presence of a visible pulsating bulge in the right groin associated with impalpable Popliteal and Pedal pulses. Preoperative imaging revealed an isolated Common Femoral Artery Pseudoaneurysm and hence, surgical intervention was successfully accomplished. CLINICAL DISCUSSION Surgical repair was achieved by pseudoaneurysmectomy and utilizing an autologous Saphenous Vein graft. From the proximal side, a primary end-to-end anastomosis was accomplished between the veinous graft and the right Common Femoral Artery (CFA). Whereas from the distal side, a direct end-to-end anastomosis was completed between the right Superficial Femoral Artery and the veinous graft. CONCLUSION Arterial pseudoaneurysms constitute immensely rare vascular emergencies. The pediatric population is particularly vulnerable because of the rarity of occurrence of this pathology in children. Surgical intervention is the gold standard approach. Meticulous follow-up protocols ought to be carried-out to limit the possibility of recurrence. Documentation is the main building block in our profession. Physicians should possess high sense of clinical awareness when presented with such a pathology.
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Affiliation(s)
- Omar Al Laham
- Department of Surgery, Al-Mouwasat University Hospital, Damascus, Syria,Department of Surgery, Al Assad University Hospital, Damascus, Syria,Corresponding author at: Department of Surgery, Al-Mouwasat University Hospital, Damascus, Syria.
| | - Ahmad Shahrour
- Department of Surgery, Al-Mouwasat University Hospital, Damascus, Syria,Department of Surgery, Al Assad University Hospital, Damascus, Syria
| | - Okab Yahya
- Department of Surgery, Al-Mouwasat University Hospital, Damascus, Syria,Department of Surgery, Al Assad University Hospital, Damascus, Syria
| | - Hisham Hamzeh
- Department of Vascular Surgery, Al-Mouwasat University Hospital, Damascus, Syria
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10
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Hawthorne SCJ, Atkinson NR, Musicki K. True Saccular Aneurysm at the Iliac Bifurcation in an Adolescent: Case Report and Review of Lower Limb Vascular Embryology. EJVES Vasc Forum 2021; 53:30-35. [PMID: 34849499 PMCID: PMC8609148 DOI: 10.1016/j.ejvsvf.2021.10.016] [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: 03/01/2021] [Revised: 09/01/2021] [Accepted: 10/18/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Isolated iliac artery aneurysms are an uncommon occurrence in the absence of concurrent aortic disease in the adult population and are a rare entity in children and adolescents. Paediatric patients may present with false aneurysms less frequently but true aneurysms are exceptional. In this report, the case of an iliac bifurcation true saccular aneurysm is described. Report An 18 year old woman without history of infection, trauma, connective tissue disorders, or vasculitis, was referred with an incidental left iliac bifurcation saccular aneurysm. She underwent open surgical resection of the aneurysm with primary re-anastomosis of the common to external iliac arteries and ligation of the internal iliac artery. Histopathological assessment did not show any inflammatory or other underlying disease process. Discussion A case is presented of an isolated iliac bifurcation true aneurysm in an adolescent and its successful treatment. It is plausible that incomplete involution of the embryologically dominant sciatic artery may have been the cause for this presentation and for other congenital iliac artery aneurysms. Literature review of other paediatric iliac aneurysms shows an array of postulated underlying causes and treatment strategies. An unusual case of a paediatric internal iliac artery aneurysm. True aneurysms are rare without connective tissue or vasculitic disorders. The initial axial sciatic artery involutes during vasculogenesis/angiogenesis. Sciatic artery involution may have lead to the formation of this aneurysm. Literature review indicates sciatic artery origins as novel for the presentation.
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Affiliation(s)
- Samuel C J Hawthorne
- Department of Vascular Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Noel R Atkinson
- Department of Vascular Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Korana Musicki
- Department of Vascular Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
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11
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Iyer H, Joharifard S, Le-Nguyen A, Dubois J, Ghali R, Borsuk DE, Lallier M. Microsurgical and Endovascular Management of Congenital Iliac Aneurysms in the Neonatal Period: Two Cases and a Literature Review. EJVES Vasc Forum 2021; 52:41-48. [PMID: 34522908 PMCID: PMC8424503 DOI: 10.1016/j.ejvsvf.2021.06.007] [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] [Indexed: 12/05/2022] Open
Abstract
Introduction Congenital aneurysms of major arteries are very rare diagnoses and prognosis can be poor if treatment is not initiated rapidly. This is the presentation of two cases of infants with congenital iliac aneurysms who underwent treatment in the neonatal period. The report then proceeds with a literature review of paediatric iliac aneurysms. Report Case 1: A female neonate was diagnosed antenatally with right common iliac (CIA) and internal iliac (IIA) artery aneurysms. Embolisation on day of life (DOL) eight was impossible because of partial thrombosis. The infant was subsequently observed for several months and the aneurysm was injected percutaneously with thrombin on DOL 78. A small residual aneurysm was coil embolised at five months of age. Satisfactory results were observed at one year follow up. Case 2: A female neonate was diagnosed antenatally on routine third trimester ultrasound with voluminous, bilateral CIA aneurysms. The patient underwent surgery on DOL 9 for aneurysm resection and microsurgical vascular reconstruction. The intervention was successful with triphasic flow through the anastomoses on colour Doppler ultrasound at six week follow up. Discussion Ten cases of congenital iliac aneurysms have been reported previously, with just two diagnosed in the neonatal period and eight undergoing surgical intervention. Definitive management to avoid aneurysm rupture or thrombosis should be timed carefully, and sometimes delayed with watchful waiting, to maximise success and minimise complications. Surgery is the key treatment modality, but endovascular intervention can be considered in selected cases. Congenital iliac aneurysms should be addressed at the safest time for the patient. Following resection, primary microvascular anastomosis is the ideal reconstructive technique, but other options for neonates have been described. Endovascular treatment should be considered for anatomically amenable saccular aneurysms.
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Affiliation(s)
- Hari Iyer
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Université de Montréal, Montréal, Québec, Canada
| | - Shahrzad Joharifard
- Department of Surgery, Division of Paediatric Surgery, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Annie Le-Nguyen
- Department of Surgery, Division of General Surgery, Université de Montréal, Montréal, Québec, Canada
| | - Josée Dubois
- Department of Radiology, Radiation-Oncology and Nuclear Medicine, Division of Paediatric Interventional Radiology, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Rafik Ghali
- Department of Surgery, Division of Vascular Surgery, Hôpital Maisonneuve-Rosemont, Montreal, Québec, Canada
| | - Daniel E Borsuk
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Université de Montréal, Montréal, Québec, Canada
| | - Michel Lallier
- Department of Surgery, Division of Paediatric Surgery, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
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12
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Zhu A, Connolly P, Hakimi AA. Endovascular management of a large renal artery aneurysm: a case report and review of the literature. BMC Urol 2021; 21:121. [PMID: 34493233 PMCID: PMC8425141 DOI: 10.1186/s12894-021-00877-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/02/2021] [Indexed: 11/17/2022] Open
Abstract
Background A renal artery aneurysm is a rare clinical presentation that can be found incidentally on imaging or during workup for refractory hypertension. Its presentation can be similar to that of a renal artery pseudoaneurysm, but the etiologies of the two vascular lesions differ. We present a patient who had an incidental finding of a large renal artery aneurysm that was managed with endovascular embolization. We also describe the literature surrounding the etiology, presentation and management of both renal artery aneurysms and renal artery pseudoaneurysms. Case presentation A 62-year-old man was referred to a urologic oncologist for workup of a newly found renal mass. Initial imaging with computed tomography showed a homogenous, well-circumscribed mass arising from the right kidney. Further evaluation with Doppler ultrasonography demonstrated pulsatile flow within the renal mass that was concerning for a renal artery pseudoaneurysm. The patient initially underwent a diagnostic angiogram by interventional radiology and was found to have a true renal artery aneurysm. Interventional radiology considered placement of a covered stent or angioembolization, but treatment was deferred due to concern for compromising the patient’s renal function. Patient was subsequently transferred to a neighboring hospital for management by vascular surgery. After considering both open surgical and endovascular approaches, the patient ultimately underwent angioembolization of the renal artery aneurysm. Short-term follow-up showed successful exclusion of the aneurysm with minimal adverse effects to the patient. Conclusions Our case report documents a unique case of an incidentally found large renal artery aneurysm that was successfully managed with endovascular embolization. Renal artery aneurysms and renal artery pseudoaneurysms, which can present similarly on imaging, are important diagnostic considerations in a patient presenting with a new renal mass. While open surgical approaches can be used to repair aneurysms, endovascular approaches using stenting or angioembolization are safe and effective options for treating renal aneurysms and renal pseudoaneurysms.
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Affiliation(s)
- Alec Zhu
- NewYork-Presbyterian/Weill Cornell Medical Center, 525 E 68th St, New York, NY, 10065, USA.
| | - Peter Connolly
- NewYork-Presbyterian/Weill Cornell Medical Center, 525 E 68th St, New York, NY, 10065, USA
| | - A Ari Hakimi
- Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
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13
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Reis JMCD, Melo GDS, Oliveira MVD, Santos FEDO, Silva TMMFD, Ferreira HLDS. Surgical Repair of a Ruptured Giant Abdominal Aortic Aneurysm in a 16-Year-Old with Takayasu’s Arteritis: Case Report and Etiological Review. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20200198] [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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14
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Falqueto LE, Martins GCL, Saito AAK, Aranha AA, Martins ZCL. Idiopathic right common iliac artery aneurysm in a three-year-old child - case report. J Vasc Bras 2021; 20:e20200195. [PMID: 34188670 PMCID: PMC8210647 DOI: 10.1590/1677-5449.200195] [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] [Indexed: 11/22/2022] Open
Abstract
The incidence of iliac aneurysms in children is unknown and there are only a small number of case reports in the literature on the subject. This article describes the case of a 3-year-old male patient with an isolated saccular aneurysm at the bifurcation of the right common iliac artery, of idiopathic origin, which was repaired by resection, ligature of the internal iliac artery and end-to-end vascular anastomosis. After 1 month of follow-up, he was diagnosed with asymptomatic occlusion of the anastomosis. The occlusion had no clinical repercussions because of collateral circulation and the child has had a favorable clinical course over the medium term.
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15
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Recurrent brachial artery aneurysm repair in a child managed with Gore-Tex conduit reinforcement. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:295-297. [PMID: 33997577 PMCID: PMC8094393 DOI: 10.1016/j.jvscit.2020.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/26/2020] [Indexed: 11/23/2022]
Abstract
Pediatric nonaortic arterial aneurysms are uncommon diagnoses and can be affiliated with underlying conditions, which include neurofibromatosis I, Ehlers-Danlos type IV syndrome, Kawasaki disease, Marfan syndrome, and Loeys-Dietz, polyarteritis nodosa, as well as Klippel-Trenauny syndrome. The standard of care has been early surgical excision and arterial reconstruction when indicated. This report details a case of recurrent brachial artery aneurysm in a 2-year-old boy despite multiple attempts at excision and reconstruction. Such recurrences were seen as rapidly as 3 months postoperatively. Ultimately, a Gore-Tex conduit was used to reinforce a reversed saphenous vein graft repair. There has been no evidence of recurrent disease during the 18-month follow-up period.
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16
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Forte AJ, Yeager TE, Boczar D, Broer PN, Manrique OJ, Parrett BM. Pediatric ulnar artery pseudoaneurysm of the wrist after glass laceration: A case report and systematic review of the literature. Microsurgery 2020; 41:84-94. [PMID: 33128477 DOI: 10.1002/micr.30676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 08/30/2020] [Accepted: 10/09/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Our purpose was to explore a case of a complicated ulnar artery pseudoaneurysm and propose an algorithm to guide physicians in this scenario. We present a case of a 5-year-old boy with a pediatric ulnar artery pseudoaneurysm that developed after a wrist laceration from broken glass 6 weeks after the initial injury. The diagnosis of pseudoaneurysm was missed, and the patient was transferred to our facility in urgent need of resection and repair due to profuse bleeding. An ultrasound confirmed the suspected diagnosis of ulnar artery aneurysm with thrombosis within the vessel. An area of skin necrosis was also present. Upon exploration of the wound, the ulnar artery pseudoaneurysm was identified and resected. The defect measured six millimeters and it was repaired primarily, under the microscope, after the proximal and distal portions were freed by dissection. The patient's incision was well healed at six-week follow-up. METHOD A systematic literature review of the English literature on ulnar artery aneurysm was conducted on PubMed/Medline, Embase, Cochrane Clinical Answers, and Cochrane Clinical Trials, without timeframe limitations. Finally, we provide an algorithm to assist the decision-making process in similar scenarios. CONCLUSION Although ulnar artery aneurysm is rare on a pediatric patient, it should be considered in the differential diagnosis each time a patient presents with a wrist mass. In such cases, a high index of suspicion warrants examination by a hand specialist.
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Affiliation(s)
| | - Tamanie E Yeager
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Daniel Boczar
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Peter Niclas Broer
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Hospital, Munich, Germany
| | - Oscar J Manrique
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian M Parrett
- Sutter Pacific Medical Foundation, San Francisco, California, USA
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17
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Aneurysm of Upper Limb Arteries in Children: Report of Five Cases. Case Rep Med 2020; 2020:9198723. [PMID: 32518564 PMCID: PMC7260628 DOI: 10.1155/2020/9198723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 05/12/2020] [Indexed: 12/05/2022] Open
Abstract
Background Arterial aneurysm in children is rare. Aim To present the description of case series of successful surgical treatment of upper limb aneurysms in children. The case series included 2 boys and 3 girls, with median age 3.3 years. One of them was a newborn with a true brachial artery aneurysm. Aneurysms were in the brachial (n = 3) and radial (n = 2) arteries. Two patients had idiopathic aneurysms. Two cases were associated with connective tissue dysplasia syndrome. One patient had a history of trauma. In 4 of 5 cases, there was a true aneurysm and in one a pseudoaneurysm. Diagnosis was carried out in all cases by using ultrasound, with arteriography in one case. All 5 children were operated on. Resection of the aneurysm and restoration of arterial patency was performed in 4 of 5 cases (ligation of the radial artery near the aneurysm in 1 case, aneurysm resection with end-to-end anastomosis in 1 case, resection with PTFE graft implantation in 1 case, and resection with implantation of an autovenous graft in 2 cases. Complications. Dysfunction and thrombosis of the PTFE graft required reoperation using an autovenous graft. Conclusion Despite the rarity of the disease, timely and adequate surgical treatment of aneurysms of the arteries of the upper extremities in children is possible successfully in a specialized hospital.
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18
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Abstract
We report a case of a 2-month-old infant with incomplete Kawasaki disease with multiple coronary and systemic arteries aneurysms complicated with internal iliac arteries thrombosis. The atypical clinical presentations and severity of systemic vascular involvements discuss the importance of high index of suspicions in younger infants and treatment options in such cases.
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19
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Irsara S, Russo F, Ferretto L. In Situ Treatment of Branch Renal Artery Aneurysms With Pantaloon Vein Graft. Vasc Endovascular Surg 2019; 54:272-277. [DOI: 10.1177/1538574419895372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: The optimal method of operative management of complex renal artery aneurysms (RAAs) involving distal branches (BRAAs) remains unclear. When more than 1 artery is involved within the BRAA, endovascular techniques are not advisable and an ex vivo approach is often preferred. In this study, we introduce an alternative surgical in situ technique to treat BRAAs. Methods and Surgical Technique: Five aneurysms involving the main or second-order bifurcation of the renal artery (RA) were treated in 4 patients at our institute between November 2012 and January 2017. The treatment of the BRAAs was based on resection of the aneurysm wall and reconstruction with autologous Pantaloon vein graft (PVG): a “Y-shaped” bypass created on-bench with autogenous great saphenous vein. Sequential clamping/reperfusion of the kidney allows to reduce renal function impairment. Results: No perioperative mortality or morbidity was observed, including none nephrectomy. In all the cases, aneurysms were treated with an in situ technique as previously planned. All the grafts were patent at the follow-up time (mean 64.1 ± 11.7 months). Renal function was preserved in all the cases. Vascularization of the renal parenchyma was satisfactory both on arterial echo Doppler and contrast-medium ultrasound in all the cases. Average cross-clamping times of the main RA and of a single branch RA were 15.8 ± 1.7 and 17.7 ± 4.6 minutes, respectively. Mean total operating time was 266.3 ± 18.9 minutes. Conclusion: The PVG with sequential clamping applied in the surgical treatment of BRAAs permits to reduce the ischemic effects to the renal parenchyma. To our knowledge, these are the first cases described in which BRAAs are treated with a PVG and our experience suggests that it is a feasible technique, with good long-term results and without severe adverse events recorded.
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Affiliation(s)
- Sandro Irsara
- Vascular and Endovascular Surgery Unit, Center for Vascular Medicine, Castelfranco Veneto, ULSS 2, Veneto Region, Italy
| | - Francesco Russo
- Vascular and Endovascular Surgery Unit, Center for Vascular Medicine, Castelfranco Veneto, ULSS 2, Veneto Region, Italy
| | - Luca Ferretto
- Vascular and Endovascular Surgery Unit, Center for Vascular Medicine, Castelfranco Veneto, ULSS 2, Veneto Region, Italy
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20
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Axillary Artery Aneurysm in a 3-Year-Old Child: A Rare Case and Review of the Literature. Ann Vasc Surg 2019; 62:499.e1-499.e4. [PMID: 31449957 DOI: 10.1016/j.avsg.2019.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 11/20/2022]
Abstract
We report a rare case of 4 cm true aneurysm of left axillary artery in a 3-year-old girl. Computed tomography angiography confirmed the diagnosis. Open surgical repair with resection and primary end-to-end anastomosis was performed. The patient did not have any complication after 1-year follow-up. Axillary artery aneurysm is extremely rare in pediatric population. Previous reports of this rare entity are discussed comprehensively.
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21
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Isolated Idiopathic Right Common Iliac Artery Aneurysm Presenting as Acute Appendicitis in a 9-Year-Old Girl: A Case Report and Literature Review. Ann Vasc Surg 2019; 61:469.e13-469.e19. [PMID: 31382004 DOI: 10.1016/j.avsg.2019.05.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 04/24/2019] [Accepted: 05/04/2019] [Indexed: 11/23/2022]
Abstract
The prevalence of iliac artery aneurysms is extremely rare in children. The most common etiologies for developing an aneurysm in children are infections, inflammatory diseases, and trauma. An idiopathic or congenital etiology is the least common cause in the pediatric population. We report a case of a 9-year-old girl with no previous history of trauma, intervention, or family history of vascular diseases who presented with a sudden severe right lower quadrant pain suggesting appendicitis. Upon examination, a large tender pulsatile mass was felt in the right lower quadrant. Ultrasound and computed tomography scans revealed a large right common iliac aneurysm. The aneurysm was noted to have a high risk of rupture due to the sudden symptomatic presentation and its large size. Therefore, the patient underwent an urgent operation, during which an aneurysmal repair was performed with an interposition graft. Postoperative ultrasound imaging showed a patent graft and no residual aneurysm. The patient has been followed up for two years, and no complications were found.
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22
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Kesler WW, Maleszewski JJ, Payatakes AH. Spontaneous radial artery pseudoaneurysm in an infant due to idiopathic medial hypoplasia - a case report. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2019; 6:69-73. [PMID: 31259203 PMCID: PMC6586101 DOI: 10.1080/23320885.2019.1614449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 04/30/2019] [Indexed: 11/17/2022]
Abstract
Spontaneous pseudoaneurysms are uncommon vascular lesions in children. A seven-month-old boy presented for management of a painless, pulsatile mass of the volar forearm identified as a pseudoaneurysm of the radial artery on imaging, definitively treated with surgical excision. Histology was concerning for fibromuscular dysplasia, without additional lesions on whole-body imaging.
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Affiliation(s)
- William W Kesler
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Joseph J Maleszewski
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Alexander H Payatakes
- Department of Orthopaedics and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
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23
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Moosa MA, Shaikh SA, Sophie Z. Rare Presentation of an Ulnar Artery Aneurysm in a Six-Month-Old Baby: Case Discussion. Ann Vasc Dis 2019; 12:74-76. [PMID: 30931063 PMCID: PMC6434350 DOI: 10.3400/avd.cr.18-00132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Ulnar artery aneurysm cases have been rarely reported in the literature previously. A number of these cases occur in the adult population and are mostly occupational associated. In children, however, this condition is much less. Only 10 cases in children have been reported in the literature to the best of our knowledge, and the minimum age was 1 year. The etiology is mainly post-traumatic. We present a case for discussion of an ulnar artery aneurysm in a 6-month-old baby with the habit of hitting his hand against a table and the floor.
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Affiliation(s)
| | - Safdar Ali Shaikh
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Ziad Sophie
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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24
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Arslan G, Karakuş A, Kuvandık G, Fansa İ. ACİL SERVİS VE ABDOMİNAL AORT ANEVRİZMASI. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2019. [DOI: 10.17944/mkutfd.359392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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25
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Shinde B, Kamerkar D, Ratta BS, Datla S, Kuntilla N, Sawant V. A case report of ulnar artery aneurysm in a 5-month-old infant with a review of literature. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2019. [DOI: 10.4103/ijves.ijves_23_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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26
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Sivaharan A, Elsaid T, Stansby G. Acute Leg Ischaemia in a Child due to a Thrombosed Popliteal Aneurysm. EJVES Short Rep 2018; 42:1-3. [PMID: 30582027 PMCID: PMC6293015 DOI: 10.1016/j.ejvssr.2018.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/21/2018] [Accepted: 10/25/2018] [Indexed: 11/06/2022] Open
Abstract
Introduction The case of an idiopathic thrombosed popliteal aneurysm is described in an otherwise healthy 6 year old child. This is the fourth reported case and the second youngest patient to present with an idiopathic isolated popliteal aneurysm. Report A 6 year old boy presented with an acutely ischaemic right foot. Computed tomography angiography confirmed a thrombosed popliteal aneurysm. A femoropopliteal bypass was performed with reversed long saphenous vein and ligation of the aneurysm. Yearly follow up is ongoing with ultrasound surveillance; the child's growth and development is unaffected, and the graft is patent. There was a readmission over six years later with claudication on the right side. There was evidence of thrombus in the graft with associated distal embolisation, which was managed conservatively with anticoagulation. Discussion Given the rarity of such presentations in the paediatric population, there is minimal good quality data to guide treatment. There have been three previous cases of idiopathic popliteal aneurysms all managed with a reversed long saphenous vein femoropopliteal bypass with resection of the aneurysm. Management should be guided based on the clinical picture and should be undertaken in specialised tertiary centres if possible. Surgical intervention is the treatment of choice in patients with an ischaemic limb. In children, idiopathic, true popliteal aneurysms are a rare clinical entity, with only three cases reported previously. Surgical options are limited; femoral popliteal bypass was performed with reversed long saphenous vein. There is minimal good quality data to guide treatment of these presentations in children; management should be undertaken in specialised centres.
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Affiliation(s)
- Ashwin Sivaharan
- Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - Tarek Elsaid
- Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - Gerard Stansby
- Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne, UK
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27
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Zouizra Z, Benbakh S, Biaou G, Boumzebra D. Ligation of the aorta for a mycotic abdominal aortic aneurysm in an infant. SAGE Open Med Case Rep 2018; 6:2050313X18761309. [PMID: 29511545 PMCID: PMC5833237 DOI: 10.1177/2050313x18761309] [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: 09/13/2017] [Accepted: 01/30/2018] [Indexed: 11/17/2022] Open
Abstract
Mycotic aortic aneurysms are exceedingly uncommon in infants and they have a high risk of rupture. Their surgical management is extremely challenging. We report a case of a 22-month-old girl who presented with abdominal pain and fever revealing a ruptured mycotic aneurysm of the infrarenal aorta. The surgical treatment consisted of a ligature of the proximal and distal ends of the aneurysm. Postoperative course was significant for hypertension. A year and a half follow-up showed no other complications. Limited data are available concerning our chosen technique, but the reported cases showed a good short-term outcome.
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Affiliation(s)
- Zahira Zouizra
- Cardiovascular Surgery Department, Mohammed VI Teaching Hospital, Marrakech, Morocco
| | - Soukaina Benbakh
- Cardiovascular Surgery Department, Mohammed VI Teaching Hospital, Marrakech, Morocco
| | - Gaël Biaou
- Cardiovascular Surgery Department, Mohammed VI Teaching Hospital, Marrakech, Morocco
| | - Drissi Boumzebra
- Cardiovascular Surgery Department, Mohammed VI Teaching Hospital, Marrakech, Morocco
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28
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Mead BS, Rana MA, Blecker NR, Riley J, Davis MS. Modified ex-vivo repair of distal renal artery aneurysm in a pediatric patient. Urol Case Rep 2018; 17:42-43. [PMID: 29321976 PMCID: PMC5755751 DOI: 10.1016/j.eucr.2017.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 10/25/2017] [Accepted: 11/17/2017] [Indexed: 11/23/2022] Open
Affiliation(s)
- Brittany S Mead
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Muhammad A Rana
- Division of Vascular Surgery, University of New Mexico, Albuquerque, NM, USA
| | - Nathan R Blecker
- Division of Vascular Surgery, University of New Mexico, Albuquerque, NM, USA
| | - Julie Riley
- Division of Urology, University of New Mexico, Albuquerque, NM, USA
| | - Michael S Davis
- Division of Urology, University of New Mexico, Albuquerque, NM, USA
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29
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Rhodes JF, Delaney JW, Fudge JC. Late follow-up after transcatheter occlusion of a thoracic aortic aneurysm for a premature infant. PROGRESS IN PEDIATRIC CARDIOLOGY 2017. [DOI: 10.1016/j.ppedcard.2017.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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30
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Kfoury E, Chen AY, Lin PH. Posterior tibial artery aneurysm in a child with SMAD3 mutation. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2017; 3:109-111. [PMID: 29349393 PMCID: PMC5764858 DOI: 10.1016/j.jvscit.2016.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/08/2016] [Indexed: 11/30/2022]
Abstract
Peripheral arterial aneurysms in children are uncommon. We report a 6-year-old boy who developed a right posterior tibial artery aneurysm with symptoms including pain and pulsatile tenderness. His genetic testing revealed a SMAD3 mutation, a condition associated with familial aortic aneurysm, early-onset of osteoarthritis, and peripheral aneurysms. The posterior tibial artery aneurysm was treated with surgical resection and primary anastomosis. The patient remained free of symptoms or aneurysm recurrence in his tibial artery 2 years later. This represents the first reported case of pediatric tibial artery aneurysm linked to a SMAD3 mutation.
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Affiliation(s)
- Elias Kfoury
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Aaron Y Chen
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Peter H Lin
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.,University Vascular Associates, Los Angeles, Calif
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31
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Hoshiko FM, Zampieri EHS, Dalio MB, Dezotti NRA, Joviliano EE. Reparo de aneurisma de artéria ilíaca roto em criança. J Vasc Bras 2017; 16:48-51. [PMID: 29930623 PMCID: PMC5829692 DOI: 10.1590/1677-5449.008616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Relatamos o caso de uma menina de 12 anos que deu entrada na unidade de emergência com quadro de abdome agudo hemorrágico, massa abdominal pulsátil e instabilidade hemodinâmica. Confirmado o diagnóstico de aneurisma roto de artéria ilíaca direita, foi realizada correção cirúrgica de emergência por reparo aberto com reconstrução extra-anatômica, utilizando enxerto sintético de fino calibre, compatível com a anatomia. O tratamento foi bem-sucedido e a criança apresentou evolução favorável em curto prazo.
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32
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Lee JH, Oh C, Youn JK, Han JW, Kim HY, Jung SE. Right iliac arterial aneurysm in a 4-year-old girl who does not have a right external iliac artery. Ann Surg Treat Res 2016; 91:265-268. [PMID: 27847800 PMCID: PMC5107422 DOI: 10.4174/astr.2016.91.5.265] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 05/12/2016] [Accepted: 05/25/2016] [Indexed: 11/30/2022] Open
Abstract
Pediatric arterial aneurysm is rare disease. Among them, idiopathic-congenital arterial aneurysm is extremely rare. This is a case report of right common iliac artery idiopathic aneurysm with absence of right external iliac artery. A 4-year-old girl who had been complaining of intermittent abdominal pain since 2 years prior presented with a right lower abdominal mass that had been palpable since 6 months prior. Abdominal CT revealed a 5.2 cm × 4.5 cm × 5.1 cm, right-sided, partially thrombosed, saccular, iliac artery aneurysm. She underwent to operation, aneurismal resection. A pathological examination confirmed that it was a true aneurysm, considering that all layers of the vascular wall were stretched with no deficit. The patient was discharged 3 days after the surgery without any complication. Five months passed since the surgery, and the patient is doing well without any abdominal or leg pain.
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Affiliation(s)
- Jeong-Hwan Lee
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Chaeyoun Oh
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Joong Kee Youn
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Ji-Won Han
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Hyun-Young Kim
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Sung-Eun Jung
- Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea
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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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Unusual cause of acute lower extremity ischemia in a healthy 15-year-old female: A case report and review of popliteal artery aneurysm management in adolescents. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2016.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Dueppers P, Duran M, Grabitz K, Schelzig H. Open Repair for Abdominal Aortic Aneurysm in a Young Boy with Tuberous Sclerosis and Review of the Literature. Ann Vasc Surg 2016; 39:286.e1-286.e5. [PMID: 27666806 DOI: 10.1016/j.avsg.2016.06.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 06/11/2016] [Accepted: 06/14/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Abdominal aortic aneurysms (AAAs) are very rare in pediatric patients and can rarely be associated with tuberous sclerosis (TS). Open surgery is the first-line therapy. We report our experience added by a review on current literature. CASE REPORT A 9-year-old boy with TS and history of 2 earlier open repairs for AAA presented to our department with a recurrent juxtarenal aortic aneurysm. We performed a polytetraflourethylene patch plasty. Postoperative course was uneventful. After 8 months, reconstruction was stable, and no recurrent aneurysm developed. CONCLUSIONS Recurrent aneurysms may develop after open surgery for TS-associated AAA. However, open surgery is the recommended therapy but requires special techniques and experience in pediatric patients.
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Affiliation(s)
- Philip Dueppers
- Department of Vascular and Endovascular Surgery, University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Mansur Duran
- Department of Vascular and Endovascular Surgery, University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Klaus Grabitz
- Department of Vascular and Endovascular Surgery, University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Hubert Schelzig
- Department of Vascular and Endovascular Surgery, University Hospital of Duesseldorf, Duesseldorf, Germany.
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Davis FM, Eliason JL, Ganesh SK, Blatt NB, Stanley JC, Coleman DM. Pediatric nonaortic arterial aneurysms. J Vasc Surg 2016; 63:466-76.e1. [PMID: 26804218 DOI: 10.1016/j.jvs.2015.08.099] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 08/21/2015] [Indexed: 10/22/2022]
Abstract
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.
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Affiliation(s)
- Frank M Davis
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich
| | - Jonathan L Eliason
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich
| | - Santhi K Ganesh
- Department of Cardiovascular Medicine, Department of Internal Medicine and Department of Human Genetics, University of Michigan, Ann Arbor, Mich
| | - Neal B Blatt
- Division of Pediatric Nephrology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Mich
| | - James C Stanley
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich
| | - Dawn M Coleman
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich.
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37
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Successful Operation for Thoracoabdominal Aortic Aneurysm in a 5-Year-Old Boy With Tuberous Sclerosis. Ann Thorac Surg 2015; 100:e119-20. [DOI: 10.1016/j.athoracsur.2015.07.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 06/22/2015] [Accepted: 07/09/2015] [Indexed: 11/23/2022]
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38
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Benrashid E, McCoy CC, Rice HE, Shortell CK, Cox MW. Mycotic Saccular Abdominal Aortic Aneurysm in an Infant after Cardiac Catheterization: A Case Report. Ann Vasc Surg 2015; 29:1447.e5-1447.e11. [DOI: 10.1016/j.avsg.2015.06.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 02/08/2015] [Accepted: 06/18/2015] [Indexed: 10/23/2022]
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39
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Shah S, Powell-Brett S, Garnham A. Pseudoaneurysm: an unusual cause of post-traumatic hand swelling. CASE REPORTS 2015; 2015:bcr-2014-208750. [DOI: 10.1136/bcr-2014-208750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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40
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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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41
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Abstract
OBJECTIVE The purpose of this article is to review the imaging findings of common and uncommon causes of renin-mediated hypertension in children using a multimodality radiologic approach. CONCLUSION Pediatric hypertension, although uncommon, is often due to aortic or renal artery narrowing. Imaging plays an important role in the diagnosis and characterization of pediatric renin-mediated causes of hypertension.
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42
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Lee JY, Kim H, Kwon H, Jung SN. Delayed rupture of a pseudoaneurysm in the brachial artery of a burn reconstruction patient. World J Emerg Surg 2013; 8:21. [PMID: 23758847 PMCID: PMC3694471 DOI: 10.1186/1749-7922-8-21] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 06/07/2013] [Indexed: 11/10/2022] Open
Abstract
A brachial artery pseudoaneurysm is a rare but serious condition that can be limb threatening. A number of reports have found that it may be the result of damage to the blood vessels around the brachial artery, either directly or indirectly, due to trauma or systemic diseases. We present our experience of delayed pseudoaneurysm rupture of the brachial artery in a rehabilitation patient with burns of the upper extremity who underwent fasciotomy and musculocutaneous flap coverage. We also provide a review of the brachial artery pseudoaneurysm.
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Affiliation(s)
- Jun Yong Lee
- Department of Plastic and Reconstructive Surgery, Uijeongbu St, Mary's Hospital, The Catholic University of Korea, 271 Cheonbo-ro, Uijeongbu-si, Gyeonggi-do 480-717, Korea.
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Sun JM, Chong SJ, Por YC. A coagulopathic neonate with radial artery pseudoaneurysm treated with microsurgical anastomosis. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-011-0683-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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44
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Iyer RS, Hanel DP, Enriquez BK, Weinberger E. Ulnar artery aneurysm causing palmar mass in 5-month-old girl. Pediatr Radiol 2012; 42:1401-4. [PMID: 22722871 DOI: 10.1007/s00247-012-2438-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Revised: 04/23/2012] [Accepted: 04/24/2012] [Indexed: 11/28/2022]
Abstract
A 5-month-old previously healthy girl presented to the emergency department with a large palpable nontender mass in the hypothenar soft tissues of her left hand. US revealed a well-demarcated nonvascular soft tissue mass. Subsequent MR imaging showed a rim-enhancing mass with heterogeneous intrinsic signal characteristics. Abscess and necrotic tumor were the primary considerations. Surgery demonstrated a thrombosed aneurysm continuous with the ulnar artery system. The aneurysm was resected and the ulnar artery was ligated at the wrist.
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Affiliation(s)
- Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
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45
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Greenberg JI, Salamone L, Chang J, Harris EJ. Idiopathic true brachial artery aneurysm in an 18-month-old girl. J Vasc Surg 2012; 56:1426. [PMID: 23083666 DOI: 10.1016/j.jvs.2011.09.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 09/13/2011] [Accepted: 09/13/2011] [Indexed: 11/25/2022]
Affiliation(s)
- Joshua I Greenberg
- Division of Vascular and Endovascular Surgery, Stanford University Medical Center, Stanford, Calif, USA
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46
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Matsubara M, Hiramatsu Y, Sugita S, Atsumi N, Terada M, Sakakibara Y. Congenital-idiopathic superficial femoral artery aneurysm in a 7-year-old child. J Vasc Surg 2011; 53:1699-701. [PMID: 21514776 DOI: 10.1016/j.jvs.2011.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 02/04/2011] [Accepted: 02/04/2011] [Indexed: 10/18/2022]
Abstract
Superficial femoral artery aneurysm in children is distinctly uncommon, and usually results from infection, vasculitis, connective tissue disorder, or trauma. We report a 7-year-old girl who had multiple fusiform aneurysms of the right superficial femoral artery, with no evidence of related disorders. The patient successfully underwent aneurysm resection and femoral artery reconstruction with autogenous saphenous vein. Histologic examination revealed intimal thickening with fibroplasia without severe inflammatory infiltrates or cystic medial necrosis, suggesting a congenital-idiopathic arterial aneurysm. Three years after the procedure, the saphenous vein graft is fully patent and the patient is in good condition.
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Affiliation(s)
- Muneaki Matsubara
- Department of Cardiovascular Surgery, Tokyo Metropolitan Children's Medical Center, Futyu, Tokyo, Japan.
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47
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Jain D, Dietz HC, Oswald GL, Maleszewski JJ, Halushka MK. Causes and histopathology of ascending aortic disease in children and young adults. Cardiovasc Pathol 2011; 20:15-25. [PMID: 19926309 DOI: 10.1016/j.carpath.2009.09.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 09/02/2009] [Accepted: 09/25/2009] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Ascending aortic diseases (aneurysms, dissections, and stenosis) and associated aortic valve disease are rare but important causes of morbidity and mortality in children and young adults. Certain genetic causes, such as Marfan syndrome and congenital bicuspid aortic valve disease, are well known. However, other rarer genetic and nongenetic causes of aortic disease exist. METHODS We performed an extensive literature search to identify known causes of ascending aortic pathology in children and young adults. We catalogued both aortic pathologies and other defining systemic features of these diseases. RESULTS We describe 17 predominantly genetic entities that have been associated with thoracic aortic disease in this age group. CONCLUSIONS While extensive literature on the common causes of ascending aortic disease exists, there is a need for better histologic documentation of aortic pathology in rarer diseases.
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Affiliation(s)
- Deepali Jain
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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48
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Pellier I, Dupuis Girod S, Loisel D, Benabidallah S, Proust A, Malhlaoui N, Picard C, Najioullah F, de Saint Basile G, Blanche S, Rialland X, Casanova JL, Fischer A. Occurrence of aortic aneurysms in 5 cases of Wiskott-Aldrich syndrome. Pediatrics 2011; 127:e498-504. [PMID: 21262885 DOI: 10.1542/peds.2009-2987] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aortic aneurysms are a rare condition in children. Here we report the occurrence of aortic aneurysms in 5 children with Wiskott-Aldrich syndrome (WAS). Three patients had a WAS score of 4, and 2 patients had a WAS score of 5, but autoimmunity was only present in 1 patient. Discovery was fortuitous in 4 cases after chest radiography or thoracic or abdominal computed tomography, which was performed to investigate unrelated symptoms; in 1 patient, thoracic pain was an alerting sign. Age at diagnosis was 10 to 16 years. Aneurysms were confined to the thoracic aorta in 4 cases and to the abdominal aorta in 1 case and were from 2 to 6 cm in size. Aortic surgery was successfully performed on the single symptomatic patient. Two other patients are alive: there has been a low progression of the aneurysm 15 years after hematopoietic stem cell transplantation in 1 patient and no evidence of progression after 12 years of follow-up without hematopoietic stem cell transplantation in the second patient. Two patients died 2 and 4 years after diagnosis from unrelated complications. A systematic retrospective search of 33 other patients with WAS for whom imaging material was available did not reveal the presence of aortic aneurysms. This unusual frequency of aortic aneurysm found in patients with WAS (5 of 38) indicates that aneurysm can be an underdiagnosed complication of WAS. It is presently unclear whether it is caused by an infectious and/or autoimmune/inflammatory process. Therefore, we suggest that aneurysms of large vessels should be systematically searched for in patients with WAS.
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Affiliation(s)
- Isabelle Pellier
- Department of Pediatrics, Unité d'Hématologie-Immunologie-Oncologie Pédiatrique, Centre Hospitalier Universitaire d'Angers, Angers, France.
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49
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Park UJ, Rho YN, Yun WS, Kim YW. A giant femoral artery pseudoaneurysm in an infant boy. J Vasc Surg 2010; 52:222. [DOI: 10.1016/j.jvs.2009.08.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 07/31/2009] [Accepted: 08/08/2009] [Indexed: 11/28/2022]
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50
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Amjad I, Murphy T, Zahn E. Diagnosis and Excision of An Ulnar Artery Aneurysm in a Two-Year-Old Boy. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2010. [DOI: 10.1177/229255031001800104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ulnar artery aneurysms in children younger than 10 years of age are rare, with fewer than 10 reported cases worldwide. Unlike adult arterial aneurysms, the etiology of these lesions in children is not well understood, and there is no accepted method for treating these lesions. The method of diagnosis and excision of an ulnar artery aneurysm that showed a favourable outcome in a two-year-old boy is presented. Different approaches to treating similar lesions have been reported, and these approaches are briefly reviewed.
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Affiliation(s)
| | | | - Evan Zahn
- Congenital Heart Institute, Miami Children's Hospital, Miami, Florida, USA
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