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Abdominal aortic aneurysm in a child with tuberous sclerosis. J Vasc Surg Cases Innov Tech 2022; 8:375-377. [PMID: 35936020 PMCID: PMC9352511 DOI: 10.1016/j.jvscit.2022.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/26/2022] [Indexed: 11/22/2022] Open
Abstract
Abdominal aortic aneurysm is rare in the pediatric population and even more uncommon in association with tuberous sclerosis. We have presented a unique case of a 3-year, 8-month-old girl who was successfully treated. She was admitted because of breakthrough seizures. A painless pulsatile abdominal mass on examination prompted an abdominal ultrasound scan, which identified a large saccular abdominal aortic aneurysm. Urgent replacement of the abdominal aorta with a 12-mm woven Dacron graft was undertaken. A postoperative ultrasound evaluation confirmed the successful repair. She was growing well when examined 7 months after surgery.
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2
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Maeno R, Isaji T, Takayama T, Hoshina K. Popliteal artery aneurysm in a 14-year-old boy with tuberous sclerosis complex. J Vasc Surg Cases Innov Tech 2022; 9:100961. [PMID: 36794044 PMCID: PMC9922967 DOI: 10.1016/j.jvscit.2022.06.016] [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: 04/13/2022] [Accepted: 06/25/2022] [Indexed: 11/27/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is rarely associated with aneurysms. We have described a patient with a popliteal artery aneurysm that was associated with TSC and occlusion of the right posterior tibial artery. The patient underwent aneurysm resection and vein graft replacement, with an uneventful postoperative course and no recurrence at 11 months of follow-up. Patients with TSC could have aneurysms in areas that will not be recognized on abdominal imaging. Physical examination of the lower extremities should be performed owing to the possibility of a popliteal artery aneurysm, and imaging studies should be performed if an aneurysm is suspected.
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Affiliation(s)
| | | | | | - Katsuyuki Hoshina
- Correspondence: Katsuyuki Hoshina, MD, PhD, Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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3
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Zhou Z, Yue Y, Ma K, Hua Z, Li Z. Congenital Abdominal Aortic Aneurysm: A Case Report and Literature Review. Front Pediatr 2022; 10:853517. [PMID: 35299672 PMCID: PMC8921522 DOI: 10.3389/fped.2022.853517] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/07/2022] [Indexed: 11/30/2022] Open
Abstract
Congenital abdominal aortic aneurysm is a rare disease with unknown etiology, and the common symptoms are abdominal pulsatile mass and pain caused by aneurysm rupture. The disease has a high mortality rate and fewer reports of surgical treatment. Here, we present a case of an idiopathic congenital abdominal aortic aneurysm. A 4-year-old boy had an abdominal pulsatile mass, and computed tomography angiography revealed an isolated infrarenal abdominal aortic aneurysm. To prevent rupture of the aneurysm, we repaired the aneurysm with artificial graft transplantation. No genetic mutation of the known congenital aneurysmal diseases was found in the whole-exome sequencing of the patient and his parents. There was no graft obstruction, and the patient grew well 40 months after surgery. Open surgery is the best treatment for idiopathic congenital abdominal aortic aneurysms. Surgical details such as timing and graft selection need to be further explored.
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Affiliation(s)
- Zhibin Zhou
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yongqiang Yue
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ke Ma
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhaohui Hua
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhen Li
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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4
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Endovascular Repair of a Descending Thoracic Aortic Aneurysm in a Pediatric Patient with Tuberous Sclerosis: A Case Report and Review of the Literature. Pediatr Cardiol 2022; 43:238-243. [PMID: 34468774 DOI: 10.1007/s00246-021-02717-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
Aortic aneurysm in children is rare, but has been described in the tuberous sclerosis complex (TSC) population. While surgical repair has been utilized as the primary means of intervention, we present the first known case reporting exclusion of a descending thoracic aortic aneurysm with percutaneous covered stent implantation in a pediatric patient with TSC. A review of the literature is also included herein.
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Hamza A, Arif A, Manzoor Bhatti A, Riaz B, Mughal UJ, Ahmed Y, Tanveer S. A Rare Case of Homocysteinemia Presenting With Multiple Aneurysms in an Adolescent Boy. Cureus 2021; 13:e17950. [PMID: 34660138 PMCID: PMC8514801 DOI: 10.7759/cureus.17950] [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] [Accepted: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
Thoracoabdominal aortic aneurysm (TAAA) is primarily a disorder of the elderly; the condition, however, is rare in children, for whom the misdiagnosis is not uncommon. It is one of the leading causes of death in the older age group worldwide, with a 4:1 male to female ratio. There are no real data about the incidence of aortic aneurysms in childhood. Although rare, an aortic aneurysm can be an important cause of mortality in children and adolescents. We present a case of an adolescent boy with a left coronary artery aneurysm, left axillary artery aneurysm, and TAAA type-IV caused by the metabolic disease homocysteinemia. He was referred to our facility when the complicated picture of the disease was discovered.
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Affiliation(s)
- Ali Hamza
- Internal Medicine, Combined Military Hospital, Lahore, PAK
| | - Anum Arif
- Vascular Surgery, Combined Military Hospital (CMH) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Ahsin Manzoor Bhatti
- Vascular Surgery, Combined Military Hospital (CMH) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Bismah Riaz
- Internal Medicine, Combined Military Hospital (CMH) Lahore Medical and Dental College, Lahore, PAK
| | | | - Yashfeen Ahmed
- Internal Medicine, Combined Military Hospital, Lahore, PAK
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6
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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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7
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Gaumetou E, Mihluedo-Agbolan KA, Souchet AS, Maupain O. Low-Back Pain Revealing an Abdominal Aortic Aneurysm in a 15-Year-Old Girl: A Case Report. JBJS Case Connect 2021; 11:01709767-202103000-00022. [PMID: 33599466 DOI: 10.2106/jbjs.cc.20.00240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
CASE An abdominal aortic aneurysm is rarely seen in children. We report the case of a 15-year-old girl who presented with lower back pain in a subfebrile setting with moderate biological inflammatory syndrome. Imaging assessment, including a spinal magnetic resonance imaging, had shown no evidence of spondylodiscitis or other spinal or renal pathology. Ten days later, she presented in hemorrhagic shock and was found to have a ruptured infected aneurysm of the abdominal aorta. CONCLUSIONS This case reminds us to include an aneurysm in the differential diagnosis of lower back pain, even in children.
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Affiliation(s)
- Elodie Gaumetou
- Service de Chirurgie pédiatrique du CHI Villeneuve Saint-Georges, Villeneuve-Saint-Georges, France
| | | | - Anne S Souchet
- Service de Chirurgie orthopédique des Cliniques universitaires Saint Luc, Bruxelles, Belgique
| | - Olivier Maupain
- Anesthésiste réanimateur, Hôpital Privé Claude Galien, Quincy sous Sénart, France
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8
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Ortega-Zhindón DB, Victorica-Guzmán O, Cervantes-Salazar JL. Aneurisma de la aorta abdominal en un lactante. CIRUGIA CARDIOVASCULAR 2020. [DOI: 10.1016/j.circv.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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9
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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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10
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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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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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12
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Acute Renal and Hepatic Failure in an Adolescent: An Unusual Presentation of Multiple Aortic Aneurysms. Pediatr Emerg Care 2015; 31:649-51. [PMID: 25411855 DOI: 10.1097/pec.0000000000000256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Aortic dissection secondary to thoracoabdominal aortic aneurysms is very uncommon in children, and this life-threatening diagnosis requires a high clinical index of suspicion. Unlike adults, in whom atherosclerosis, inflammation, and advanced age are typically contributing factors, aortic dissection in children is usually due to nonatherosclerotic causes.Aortic aneurysms can be asymptomatic when small but, when significantly enlarged, can compromise organ function and dissect, resulting in high mortality rates. It is therefore critical that children with this uncommon condition be identified early when medical or surgical management can potentially improve outcome. We describe a 15-year-old patient with multiple aortic aneurysms with dissection whose presentation includes chronic anemia, acute-on-chronic renal failure with hyperkalemia, and liver injury.
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14
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Böckler D, Erhart P, Haußer-Siller I, Ellert E, Meredig H, Kovacs B. Klippel-Trénaunay-Weber syndrome associated with abdominal aortic aneurysm in childhood. J Vasc Surg Cases 2015; 1:174-176. [PMID: 31724611 PMCID: PMC6849920 DOI: 10.1016/j.jvsc.2015.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 04/16/2015] [Indexed: 01/19/2023] Open
Abstract
Klippel-Trénaunay-Weber syndrome (KTWS), also known as angioosteohypertrophy syndrome, is a rare congenital malformation with unknown etiology characterized by the combination of capillary malformations (port-wine strain), venous varicosities, and a soft tissue or bony hypertrophy of the affected limb. It is known to be rarely associated with abdominal aortic aneurysm (AAA) in adults. We report the first published case of KTWS and a rapidly progressing symptomatic AAA undergoing open repair in a child. This underlines the importance of AAA screening and treatment rather than surveillance in patients with KTWS.
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Affiliation(s)
- Dittmar Böckler
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Philiipp Erhart
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Elena Ellert
- Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Hagen Meredig
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Bence Kovacs
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany
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15
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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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Abstract
Ascending aortic aneurysm is uncommon in the paediatric population, and because of the rarity the aetiology, natural progression, and prognosis of the disease remain unknown. A 7-year-old boy with ascending thoracic aortic aneurysm (60×67 mm) underwent graft anastomosis from the sinotubular junction to the undersurface of the arch. Analytical determinations including karyotyping and genetic mapping were all normal. To our knowledge, idiopathic aneurysm of the ascending aorta in children is very rare.
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17
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Austin EH. Invited commentary. Ann Thorac Surg 2011; 93:205-6. [PMID: 22186440 DOI: 10.1016/j.athoracsur.2011.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 08/29/2011] [Accepted: 09/02/2011] [Indexed: 10/14/2022]
Affiliation(s)
- Erle H Austin
- Department of Surgery, University of Louisville and Kosair Children's Hospital, 201 Abraham Flexner Way, Ste 1200, Louisville, KY 40202, USA.
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