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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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2
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Umibe T, Nishiori H, Koizumi S, Ikeuchi H, Matsumiya G. Saccular abdominal aortic aneurysm in adolescence with tuberous sclerosis. Clin Case Rep 2024; 12:e8715. [PMID: 38562571 PMCID: PMC10982115 DOI: 10.1002/ccr3.8715] [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: 12/18/2023] [Accepted: 01/07/2024] [Indexed: 04/04/2024] Open
Abstract
Key clinical message Abdominal aortic aneurysm complicated by tuberous sclerosis is rare, particularly in patients over the age of 10. It is important to screen for abdominal aortic aneurysm in adolescents diagnosed with tuberous sclerosis regularly. Abstract A 15-year-old girl who was diagnosed with tuberculous sclerosis complicated with a saccular aortic abdominal aneurysm (AAA), measuring 19 × 18 mm in diameter. The patient underwent open repair of AAA using a 11 mm straight prosthetic graft. It is important to screen for AAA in adolescents diagnosed with tuberous sclerosis regularly.
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Affiliation(s)
| | - Hironobu Nishiori
- Department of Cardiovascular SurgeryChiba University HospitalChibaJapan
| | - Shintaro Koizumi
- Department of Cardiovascular SurgeryChiba University HospitalChibaJapan
| | - Hiroki Ikeuchi
- Department of Cardiovascular SurgeryChiba University HospitalChibaJapan
| | - Goro Matsumiya
- Department of Cardiovascular SurgeryChiba University HospitalChibaJapan
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Fuson OI, Hirai K, Halleran DR, Jafri M, Muralidaran A, Azarbal A, Abraham CZ, Shalhub S. Open repair of a ruptured abdominal aorta with an aortoiliac vein fistula in a 7-month-old infant and review of the literature. J Vasc Surg Cases Innov Tech 2024; 10:101441. [PMID: 38464889 PMCID: PMC10921241 DOI: 10.1016/j.jvscit.2024.101441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/19/2024] [Indexed: 03/12/2024] Open
Abstract
Ruptured abdominal aortic aneurysms are extremely rare in the pediatric population. In this video case report, we describe the successful repair of a ruptured abdominal aortic aneurysm in a 7-month-old female infant.
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Affiliation(s)
- Olivia I. Fuson
- Division of Vascular and Endovascular Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Kelsi Hirai
- Division of Vascular and Endovascular Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Devin R. Halleran
- Division of Pediatric Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Mubeen Jafri
- Division of Pediatric Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Ashok Muralidaran
- Division of Cardiac Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Amir Azarbal
- Division of Vascular and Endovascular Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Cherrie Z. Abraham
- Division of Vascular and Endovascular Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR
| | - Sherene Shalhub
- Division of Vascular and Endovascular Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR
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Auen T, Linde E. An Autopsy Case of Abdominal Aortic Aneurysm in a Pediatric Decedent With Tuberous Sclerosis Complex. Am J Forensic Med Pathol 2024; 45:72-76. [PMID: 37486961 DOI: 10.1097/paf.0000000000000860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
ABSTRACT Vascular involvement in tuberous sclerosis complex (TSC) is uncommon and even more so in pediatric patients. When asymptomatic, these vascular abnormalities carry increased risk of rupture with increased morbidity and mortality. Here, we describe a case of a ruptured unrecognized abdominal aortic aneurysm in an 11-month-old patient with a history of TSC. The abdominal aortic aneurysm was discovered at autopsy and highlights the rarity of abdominal aortic aneurysm in pediatric patients diagnosed with TSC and the importance of screening for associated aneurysmal disease in the pediatric population with TSC. Furthermore, the extensive retroperitoneal hemorrhage seen in this case also highlights a rare but potential mimic of abuse in the pediatric population.
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Affiliation(s)
- Thomas Auen
- From the Department of Pathology and Microbiology, Nebraska Medical Center, University of Nebraska Medical Center
| | - Erin Linde
- Physicians Laboratory Services, Omaha, NE
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Corso-Ramirez JM, López MM, Flórez PC, Barrera-Carvajal JG, Mackenzie JC. Open Emergency Repair of a Thoracoabdominal Aortic Aneurysm on a 12-Year-Old Boy With Tuberous Sclerosis. Vasc Endovascular Surg 2024; 58:85-89. [PMID: 37318445 DOI: 10.1177/15385744231184509] [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: 06/16/2023]
Abstract
Tuberous sclerosis complex is a neurocutaneous syndrome caused by an autosomal dominant genetic disorder. This condition can lead to the expression of many vascular anomalies especially, in the pediatric population. Likewise, it has been linked with aortic aneurysm development. We report a case of a 12-year-old boy who presented a 97 × 70 mm Crawford type IV thoracoabdominal aortic aneurysm. Satisfactory open surgical repair was performed with an 18-mm multibranched dacron tube graft. Clinical and imaging findings revealed a de novo tuberous sclerosis diagnosis. The patient was discharged uneventfully during a 1-month follow-up.
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Affiliation(s)
- Julian M Corso-Ramirez
- Vascular and Endovascular Surgery Research Group, Fundación CardioInfantil- La Cardio, Bogotá D.C, Colombia
| | - Mariana Molina López
- Vascular and Endovascular Surgery Research Group, Fundación CardioInfantil- La Cardio, Bogotá D.C, Colombia
| | - Paula Camila Flórez
- Vascular and Endovascular Surgery Fellowship, Fundación CardioInfantil- La Cardio, Bogotá D.C, Colombia
| | | | - Jaime Camacho Mackenzie
- Vascular and Endovascular Surgeon, Fundación CardioInfantil- La Cardio, Bogotá D.C, Colombia
- Cardiovascular Surgeon, Fundación CardioInfantil- La Cardio, Bogota D.C, Colombia
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Alrazim AM, Burk JK, Wilder TJ, Park WM, Yoon WJ, Cho JS. Recurrent symptomatic aortic aneurysm in a young girl with tuberous sclerosis complex and review of the literature. J Vasc Surg Cases Innov Tech 2023; 9:101261. [PMID: 38106352 PMCID: PMC10725066 DOI: 10.1016/j.jvscit.2023.101261] [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: 03/17/2023] [Accepted: 06/06/2023] [Indexed: 12/19/2023] Open
Abstract
An abdominal aortic aneurysm is a rare occurrence in pediatric populations. When present, it is usually associated with an underlying etiology such as a connective tissue disorder, inflammatory process, or noninflammatory medial degeneration. In the present report, we describe the case of a girl with tuberous sclerosis complex who underwent successful emergency open repair of a symptomatic infrarenal abdominal aortic aneurysm and recurrent type IV thoracoabdominal aortic aneurysm.
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Affiliation(s)
- Ayman M. Alrazim
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals, Harrington Heart & Vascular Institute, Cleveland, OH
| | - Joshua K. Burk
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals, Harrington Heart & Vascular Institute, Cleveland, OH
| | - Travis J. Wilder
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals, Harrington Heart & Vascular Institute, Cleveland, OH
| | - Woosup Michael Park
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals, Harrington Heart & Vascular Institute, Cleveland, OH
| | - William J. Yoon
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals, Harrington Heart & Vascular Institute, Cleveland, OH
| | - Jae S. Cho
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals, Harrington Heart & Vascular Institute, Cleveland, OH
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