Extensive congenital abdominal aortic aneurysm and renovascular disease in the neonate

Open repair of an abdominal aortic and right common iliac artery aneurysm with idiopathic retroperitoneal fibrosis in a 19-month-old infant

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.

Neonatal Microsurgical Repair of a Congenital Abdominal Aortic Aneurysm with a Cadaveric Graft

Congenital abdominal aortic aneurysms (AAA) are an extremely rare entity. We present the case of a female fetus diagnosed with an AAA on routine prenatal ultrasound. A postnatal computed tomography angiogram revealed an infrarenal AAA with a narrow proximal neck. Surgery was performed on day of life 14 using a cadaveric femoral artery graft. The proximal anastomosis was performed under the microscope given the severity of the aortic stenosis and the proximity of the renal arteries. The patient's postoperative course was uneventful and she is developing normally 1 year after surgery. The graft remains permeable, albeit with evidence of proximal and distal stenosis and graft calcification on imaging.

Sonographic evaluation of renovascular hypertension in the pediatric population: State-of-the-art

Hypertension in children affects 2-5% of the pediatric population. Identifying secondary causes of hypertension is crucial, as some of these entities may be treatable. Renovascular hypertension accounts for 5-10% of the secondary causes of hypertension in children and is mainly related to fibromuscular dysplasia and neurofibromatosis type 1. Ultrasonographic evaluation of the kidneys, including Doppler interrogation, is the recommended primary screening tool. A comprehensive study of the upper abdomen and retroperitoneum allows for identification of additional underlying etiologies. The purpose of this review is to emphasize the different causes of renovascular hypertension in children one can diagnose during the initial ultrasonographic evaluation. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:282-292, 2017.

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

Background

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

Methods

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

Results

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

Conclusions

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

An idiopathic congenital abdominal aortic aneurysm with impending rupture in a 23-month-old boy

Abdominal aortic aneurysms are distinctly uncommon in infants and children. These aneurysms, which are idiopathic in nature without any definite predisposing factors, are exceedingly rare. We present the case of a giant idiopathic congenital infrarenal abdominal aortic aneurysm with impending rupture in a 23-month-old boy, which was successfully treated with surgical repair using a cryopreserved cadaveric allograft. To the best of our knowledge, this is the oldest case and the third successful treatment of an idiopathic congenital abdominal aortic aneurysm repaired with a cryopreserved allograft in infants and children. Continued follow-up with multimodality imaging is required.

Endovascular treatment of a congenital thoracic aortic aneurysm in a premature newborn

Congenital aortic aneurysms are a rare, life-threatening disorder that present complex treatment challenges. The authors describe a congenital thoracic aortic aneurysm treated by endovascular means with stent-assisted coil deployment. Because of rapid in utero aneurysm growth and cardiac dysfunction, a 2.6-kg male was delivered expeditiously by Cesarean section at 35(2)/(7) weeks' gestation. On day of life 1, bilateral femoral arterial access was used to deliver a balloon-expandable stent across the wide-necked aneurysm. Microcoil embolization of the aneurysm via a prepositioned microcatheter was then performed. The child had an uncomplicated hospital course and is asymptomatic 5 months later, with complete aneurysm thrombosis.