Aortic aneurysm resulting from umbilical artery catheterization: case report, literature review, and management algorithm

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.

Low-Back Pain Revealing an Abdominal Aortic Aneurysm in a 15-Year-Old Girl: A Case Report

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.

Ascending aorta mycotic aneurysm in a child secondary to subacute infective endocarditis on the basis of congenital aortic stenosis demonstrated by cardiac computerized tomography

Infective endocarditis (IE) is rarely seen in children, and it can cause significant morbidity and mortality. Congenital heart disease is a predisposing cardiac condition for IE and has an increasing prevalence. A mycotic aortic aneurysm is a rare disease due to infection and it has been reported that it may be a result of IE. We present a 10-year-old boy who was referred to our cardiovascular surgery department due to severe aortic stenosis (AS). Transthoracic echocardiography revealed calcific severe AS and computerized tomography (CT) angiography was performed to better evaluate the ascending aorta. CT angiography demonstrated a saccular aneurysm of the ascending aorta. The underlying pathology was considered as chronic IE on top of congenital AS with an unknown number of cusps. Histologic findings supported our diagnosis and accompanied by a saccular aneurysm. The patient underwent a successful aortic root enlargement, mechanical aortic valve replacement, and ascending aorta repair surgery.

Ruptured abdominal aortic aneurysm in an 11-year-old with multiple peripheral artery aneurysms

Pediatric abdominal aortic aneurysms (AAAs) are rarely encountered in clinical practice. The combination of a pediatric AAA in a patient with multiple peripheral artery aneurysms is even more rare. We report the management of an 11-year-old boy who presented with a ruptured AAA who also had multiple peripheral arterial aneurysms. Infectious, genetic, and inflammatory workup was negative, classifying this aneurysm as congenital.

Endovascular Repair of Thoracic Aortic Pseudoaneurysms in Children

Pediatric aortic pseudoaneurysms are rare and can result in life-threatening sequelae. We describe 2 cases of exclusion of descending thoracic aortic pseudoaneurysm by different approaches, chosen based on the anatomy and cause of the lesions. (Level of Difficulty: Beginner.)

Umbilical artery catheter, aortic dissection, carotid cannulation, and pseudoaneurysm in a neonate: A tale of propagating pathology

Arterial dissections are uncommon in neonates. Complications include thrombosis, bleeding, dissection, aneurysm and pseudoaneurysm. We report an unusual case of multisite pathology (dissection and pseudoaneurysm) following common vascular interventions. A term neonate with antenatal diagnosis of congenital heart block secondary to maternal lupus deteriorated clinically at 5 days of life. He was found to have an abdominal aortic thrombus secondary to abdominal aortic dissection, following umbilical arterial catheter placement. Attempted percutaneous treatment was complicated by dissection of the left common carotid artery and formation of a large pseudoaneurysm. Neonatal lupus is associated with weakened vessel wall which may be vulnerable to injury from line placement and endovascular interventions. Various options are available to manage arterial dissection, thrombus, and pseudoaneurysm, but consequences of these options need to be carefully weighed to minimize further complications.

Ligation of Common Iliac Artery Mycotic Aneurysm in a Neonate and Review of the Literature

BACKGROUND

Mycotic aortoiliac aneurysms in neonates are rare. Surgical treatment has traditionally been the standard of care, but recent case reports have suggested that endovascular management of mycotic iliac aneurysms may also be safe and effective. In this case, we describe successful management of a mycotic aortoiliac aneurysm in a neonate with exploratory laparotomy and ligation of the left common iliac artery.

METHODS

A full-term infant boy of uncomplicated delivery was transferred to our institution on day 2 of life after a barium enema concerning for small left colon syndrome. An umbilical artery catheter had been placed for monitoring but was removed before transfer. During his hospital course, he developed left leg edema and fever. He was found to have a mycotic aneurysm of the left common and internal iliac arteries, causing common iliac venous compression. A repeat ultrasound revealed the aneurysm measured a maximum of 12 mm in diameter and 26 mm in length.

RESULTS

Treatment was delayed until the patient was clinically stable. He was monitored with serial ultrasounds, which showed no significant increase in aneurysmal size. A review of the literature supported the perception the aneurysm posed an impending risk to the patient. On day 16 of life, the neonate underwent ligation and excision of the left common iliac artery aneurysm.

CONCLUSION

Our experience found ligation of the common iliac artery to be safe and effective, establishing that surgical reconstruction is not required.

Ligation of the aorta for a mycotic abdominal aortic aneurysm in an infant

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.

Vessel Perforation and False Tracking Resulting From Umbilical Artery Catheterization: A Case Report and Literature Review

We report an extremely low-birth-weight neonate who developed umbilical artery perforation and false tracking. There was no life-threatening event relating to the complication. Diagnosis was made at postmortem examination. Little information exists regarding the anatomic and vascular effects of umbilical artery catheterization placement in newborns. We report a new complication of umbilical artery catheterization. We raise the awareness regarding the potential life threat due to this rare but very serious complication.

Pediatric Vascular Surgery Review with a 30-Year-Experience in a Tertiary Referral Center

Pediatric vascular disease is rare, and remains a big challenge to vascular surgeons. In contrast to adults, surgery for pediatric vascular disease is complicated by issues related to small size, future growth, and availability of suitable vascular conduit. During the last 30 years, 131 major vascular operations were performed in a tertiary referral center, Seoul National University Hospital, including aortoiliac aneurysm, acute or chronic arterial occlusion, renovascular hypertension, portal venous hypertension, trauma, tumor invasion to major abdominal vessels, and others. Herein we review on the important pediatric vascular diseases and share our clinical experiences on these rare diseases.

[Successful endovascular treatment of thoracic aortic aneurysm secondary to infection of the umbilical artery catheter in preterm infants]

Aortic aneurysms (AA) in the paediatric population are uncommon. The use of umbilical catheters in neonates has been associated with infections and, on some occasions, the formation of aortic aneurysms. The surgical repair of these aneurysms is one type of treatment; however, percutaneous intervention with stents could provide an alternative treatment route, with fewer complications. The aim of this report is to present the therapeutic scope of a hybrid procedure, in which the combined surgical and percutaneous technique offers a less invasive alternative to open surgery for the repair of aortic aneurysms or their main branches.

CLINICAL CASE

The case concerns a pre-term newborn of 30 weeks weighing 1,335 g. An umbilical catheter was introduced, which was withdrawn at 14 days due to an infection. It developed as Staphylococcus aureus with sepsis. The echocardiogram and Angio-CT confirmed AA, which were managed using a hybrid procedure of surgery and the endovascular implantation of 2 coated stents (Atrium V12 XR Medical Corp, Hudson, NH). The post-procedure clinical follow-ups, including abdominal echo-tomography, confirmed the success of the treatment.

CONCLUSION

The endovascular aortic aneurysm repair procedure in premature newborns may be considered when deciding treatment of this disease, and could avoid the risks associated with open surgery. However, follow-up and monitoring is required while the patient grows up, due to the possibility that the implanted stents require re-dilating. The outcomes of neonatal endovascular procedures in the future are unknown.

Repair of idiopathic ascending aortic aneurysm in a 7-year-old child

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.

Imaging diagnosis-aortic aneurysm and ureteral obstruction secondary to umbilical artery abscessation in a 5-week-old foal

A 5-week-old foal was evaluated for fever and hematuria of 3 days duration. Cystoscopy localized the blood to be originating from the left ureter. Abdominal ultrasonography revealed left hydronephrosis, hydroureter, and omphaloarteritis of the left umbilical artery with abscess formation that communicated with an arterial structure. Computed tomography (CT) revealed a large aortic aneurysm within the center of the abscess. An exploratory celiotomy was performed and the infection was nonresectable. The prognosis for life was grave; therefore the colt was euthanized. Necropsy findings confirmed the antemortem diagnosis. Ultrasound and CT imaging in this case provided an accurate antemortem diagnosis.

Mycotic aneurysm of ascending aorta in an infant

Mycotic aneurysm of the ascending aorta is rare in infants. A 12-month-old infant developed a mycotic aneurysm of the ascending aorta secondary to group A streptococcus septicemia. He developed atrioventricular block, and the rapid aneurysm progression under medical therapy prompted us to perform an emergency operation. The aneurysm was successfully repaired using an autologous pericardial patch. He remained well with normal sinus rhythm and was developing normally at the 5-year follow-up.

Quantitative anatomy of the growing abdominal aorta in human fetuses: an anatomical, digital and statistical study

Background

Advances in perinatal medicine have required an extensive knowledge of fetal aorto-iliac measurements. The present study was performed to compile reference data for dimensions of the abdominal aorta at varying gestational ages.

Material/Methods

Using the methods of anatomical dissection, digital-image analysis (Leica QWin Pro 16 system), and statistical analysis (Student’s t-test, one-way ANOVA, post-hoc RIR Tukey test, regression analysis, and Wilcoxon signed-rank test), the growth of length (mm), proximal and distal external diameters (mm), and volume (mm³) of the abdominal aorta in 124 (60 male, 64 female) spontaneously aborted human fetuses aged 15–34 weeks was examined.

Results

No significant male-female differences were found. The length ranged from 9.35±1.24 to 36.29±4.98 mm, according to the linear function y=−14.596+1.519 × Age ±2.639 (R²=0.92; p<0.0001). The proximal external diameter varied from 1.18±0.25 to 5.19±0.49 mm, according to the linear pattern y=−2.065+0.212 × Age ±0.348 (R²=0.92; p<0.0001). The distal external diameter increased from 1.03±0.23 to 4.92±0.46 mm, in accordance with the linear model y=−2.097+0.203 × Age ±0.351 (R²=0.92; p<0.0001). Both length and proximal external diameter of the abdominal aorta indicated a proportionate evolution, because the length-to-proximal external diameter ratio was stable, following the linear function y=7.724–0.017 × Age ±0.925. The abdominal aorta volume ranged from 9.6±4.5 to 740.5±201.8 mm³, given by the quadratic function y=911–101 × Age +2.838 × Age² ±78 (R²=0.89; p<0.0001).

Conclusions

There are no significant differences between males and females for morphometric parameters of the abdominal aorta. The abdominal aorta grows linearly in both length and diameters, and parabolically in volume. These detailed morphometric data of the abdominal aorta provide a database for intra-uterine echographic examinations in the early diagnosis, monitoring and management of aorto-iliac malformations.

Clinical outcome of umbilical artery catheter-related thrombosis - a cohort study

OBJECTIVE

To reveal the incidence of umbilical artery catheter-related thrombosis (UACRT), the associated risk factors and the natural history of clot formation and regression.

STUDY DESIGN

A prospective cohort study. An umbilical artery catheter was inserted in 61 infants, who were evaluated and followed by serial duplex ultrasound studies for the development of UACRT, renal artery resistance index (RI) and clot resolution. Maternal and infant clinical variables were correlated with the characteristics of thrombi.

RESULT

Nineteen infants developed UACRT, all resolved spontaneously without sequella; most had maximal length at the first evaluation. No correlation was found between the thrombus length and time to resolution. The RI did not differ between the infants with and without UACRT. After adjusting for possible confounding, catheter days was the only covariate associated with UACRT.

CONCLUSION

Asymptomatic UACRT in our cohort was a self-resolving disease; it was associated with catheter days and did not necessitate medical treatment.

Recurrent mycotic aneurysm in a 2-year-old boy with group A Streptococcus bacteremia

Mycotic aneurysms represent less than 1% of all reported aneurysms, most of which occur in adults. We present the case of a 2-year-old boy with Streptococcus pyogenes bacteremia and a recurrent mycotic aneurysm.

Extensive congenital abdominal aortic aneurysm and renovascular disease in the neonate

Primary congenital abdominal aortic aneurysm is an extremely rare entity, with only 15 patients reported in the literature. Options for repair are often limited secondary to branch vessel size and other anatomic limitations. We present a neonate diagnosed with an abdominal aortic aneurysm on prenatal ultrasound. A postpartum computed tomography angiogram revealed an extensive type IV thoracoabdominal aortic aneurysm extending to the aortic bifurcation and resulting in bilateral renal artery stenosis. The unique features of this patient and challenges in management are discussed.

Infected common iliac artery aneurysm repaired in an infant with cadaveric vein graft

Aneurysms are rare in children. Causes include congenital, traumatic, inflammatory, and infectious etiologies. When and how to best surgically treat arterial aneurysms in a child remain unclear. We present the case of a 3-month-old child with an aneurysm of the left common iliac artery, which was first detected on abdominal ultrasound and was successfully repaired with a cadaveric vein graft.

Distal aortic aneurysm presumed to be secondary to an infected umbilical artery in a foal

CASE HISTORY

A 3-month-old female Warmblood foal was presented after displaying signs of colic with pyrexia for 5 days.

CLINICAL AND PATHOLOGICAL FINDINGS

The foal continued to show signs of colic, frequently passed urine, and was pyrexic with an elevated white blood cell count. The umbilical stalk was thickened but there was no evidence of purulent material. Exploratory laparotomy revealed an enlarged left umbilical artery remnant tightly adhered to the bladder wall. The left umbilical artery continued to an aneurysm involving the distal aorta. The foal was subject to euthanasia and post-mortem examination confirmed a spherical aortic aneurysm, in the dorsal midline caudal to the kidneys that contained a large thrombus. Histopathological examination revealed inflammation and necrosis of the tunica intima and tunica media of the left umbilical artery with suppuration and bacterial colonies evident in the periarterial tissues.

DIAGNOSIS

Infected aortic aneurysm presumably caused by an umbilical artery infection.

CLINICAL RELEVANCE

A previously undetected umbilical infection appears to have resulted in an unusual delayed complication causing signs of colic in a foal. Veterinarians should be aware of this condition, and the possibility that it may be a cause of signs of colic in foals. Diagnosis based on ultrasonography should be possible, but may require sedation, visceral analgesia and careful examination.

Mycotic aneurysm of the thoracoabdominal aorta in a child with end-stage renal disease

A 5-year-old child with nephrotic syndrome developed a mycotic saccular thoracoabdominal aortic aneurysm (TAAA) involving the visceral segment within a 4-month period following pneumococcal bacteremia and presumed spontaneous bacterial peritonitis (SBP). Due to continued aneurysm growth and progression to end-stage renal disease, TAAA repair was performed, followed by cadaveric kidney transplantation. This is the first known instance of mycotic aortic aneurysm formation as a consequence of SPB and the first report of TAAA repair in preparation for kidney transplantation in a child.

From arteritis to mycotic aneurysm: visualization of the progression of mycotic aneurysm development following femoral arterial line insertion in an infant

Although uncommon, mycotic aneurysms in infants can be lethal because of the high risk of rapid expansion and rupture. Most catheter-associated mycotic aneurysms reported in the first year of life develop following umbilical artery catheterizations. We describe the sonographic detection of an early stage mycotic aneurysm in a 4-month-old following femoral artery catheterization complicated by methicillin-resistant Staphylococcus aureus (MRSA) septicemia. We also describe the sonographic and radiographic progression of this mycotic aneurysm before surgery.

Development of the abdominal aorta and iliac arteries during the fetal period: a morphometric study

PURPOSE

This study aimed to determine the location and morphometric development of the fetal abdominal aorta and the iliac arteries.

METHODS

The study was carried out between 1996 and 2008 on 172 spontaneously aborted human fetuses (76 males and 96 females) aged between 9 and 40 weeks. None of the fetuses had any external pathology or anomaly. The location of the abdominal aorta was determined in reference to the vertebral column. This was followed by measurements of the lengths, external diameters of the origin of the aorta, and bifurcation of aorta as well as the bifurcation angles of the abdominal aorta. The vertebral levels at which the abdominal aorta started and bifurcated were determined. The lengths and external diameters of the common iliac arteries, diameters of the internal and external iliac arteries, and lengths of the external iliac arteries were measured. The vertebral levels of bifurcation of the common iliac arteries were determined.

RESULTS

The fetal abdominal aorta lay in the midline, in front of the vertebral column. The mean bifurcation angle of the abdominal aorta was greater than adults in the third trimester and at full term. The lengths and diameters of the abdominal aorta and the iliac arteries increased with gestational age, and significant positive correlations were found. There were no sex or laterality differences in either parameter. External diameter of the internal iliac artery was larger than that of the external iliac artery. Bifurcation of the abdominal aorta to the common iliac arteries was more inferior compared to the adults, and these levels rose with gestational age.

CONCLUSION

The morphometric parameters and location of the fetal abdominal aorta and the iliac arteries were determined by the present study. We conclude that the abdominal aorta lay in the midsagittal plane. The bifurcation level of the abdominal aorta arose with gestational age and at full term, and reaches to the same level as adults. In the early fetal period, the bifurcation level of the common iliac artery was more inferior compared to the adults, and they reach the adult positions around full term. The diameter of the internal iliac artery was nearly one and a half times larger than the external iliac artery. The findings of this study would be present, detailed information about the development of the abdominal aorta and the iliac arteries; this will also contribute to radiological (ultrasound and MR) studies in the intrauterine period.

Anatomical repair of a congenital aneurysm of the distal abdominal aorta in a newborn

Congenital (primary) neonatal abdominal aortic aneurysm (AAA) is an extremely rare truncular arterial abnormality among numerous congenital vascular malformations. Only seven cases have been reported as congenital origin in newborns. This report presents the case of a male infant in whom a 33-mm congenital AAA was diagnosed prenatally and was successfully treated 10 days after birth without exogenous graft material or aneurysmorrhaphy. Follow-up study at 39 months demonstrated excellent clinical, ultrasound scan, and computed tomography scan findings. Anatomic reconstruction with native vessels is the preferred surgical technique to ensure the child's potential for harmonious growth.

Primary congenital abdominal aortic aneurysm: a case report with perinatal serial follow-up imaging

Abdominal aortic aneurysms in neonates and infants are rare and are usually associated with infection, vasculitis, connective tissue disorder, or iatrogenic trauma such as umbilical catheterization. An idiopathic congenital abdominal aortic aneurysm is the least common category and there are few descriptions of the imaging features. We present the antenatal and postnatal imaging findings of an idiopathic congenital abdominal aortic aneurysm including the findings on US, MRI and CT.

Ruptured abdominal aortic aneurysm in an 11-year-old boy

We present a case of a ruptured aortic aneurysm in an 11-year-old boy presenting with loss of consciousness. The presentation, management, pathology, and gravity of this condition are discussed.

Calcified aneurysm of the abdominal aorta 12 years after umbilical artery catheterization

We report a 12-year-old boy who presented with abdominal pain and who was found to have an aneurysm of the abdominal aorta (AAA). The patient was born from a quadruplet pregnancy induced by in vitro fertilization. Postnatal transient respiratory distress required assisted ventilation that had been monitored by two consecutive umbilical arterial catheters (UAC). AAA is a rare condition in childhood. Infection and/or trauma are known to be the most frequent causes. Most of the reported cases have occurred in children in whom a UAC had been placed during the neonatal period. In this patient the delay between UAC placement and diagnosis was considerable. At the time of this report the patient had remained well during a follow-up of 8 years after treatment.

Mycotic Aneurysm of the Descending Thoracic Aorta in a 2-kg Neonate

Umbilical artery catheterization is often performed in critically ill neonates. Infection and thromboembolic events are relatively frequent complications, but aneurysm formation is rare. We describe the case of a premature baby who developed a rapidly expanding aneurysm of the descending thoracic aorta, secondary to a highly placed infected umbilical catheter. The rapid progression under medical therapy prompted us to replace the thoracic aorta with an 8-mm polytetrafluoroethylene graft, using extracorporeal circulation and core cooling. The baby had an excellent recovery and was discharged home after a prolonged antibiotic course. He is being followed with repeated imaging studies for a small abdominal aneurysm. We describe a novel approach to this rare and complicated problem and provide a review of the literature on the subject.

Idiopathic renal artery and infrarenal aortic aneurysms in a 6-year-old child: case report and literature review

Multiple arterial aneurysms are distinctly rare in the pediatric population. Most arterial aneurysms in children are secondary to infections, trauma, arteritides, collagen vascular diseases, and other causes. True idiopathic aneurysms are the least common and less than a dozen reports of multiple idiopathic aneurysms have been published. We present a case of an idiopathic, symptomatic renal artery aneurysm with fistulization to the renal vein and a concomitant abdominal aortic aneurysm in a 6-year-old boy. The diagnostic workup, surgical treatment, pathologic findings, and a review of the literature are presented.

Hypertensive emergency associated with thoracoabdominal aneurysm: case report and review

OBJECTIVE

To provide a description and thorough discussion of the diagnostic considerations for a rare case of malignant hypertension and aortic aneurysm in a pediatric patient.

DESIGN

Case report.

SETTING

A university pediatric intensive care unit.

SUBJECT

A young child with a hypertensive crisis and a thoracoabdominal false aortic aneurysm.

INTERVENTIONS

The child required urgent surgical intervention to resect the aneurysm and aggressive medical therapy in the pediatric intensive care unit to treat the underlying hypertension.

CONCLUSIONS

Hypertensive emergencies and aortic aneurysms are unusual but potentially lethal entities in pediatric patients, requiring a high index of suspicion, prompt initiation of medical therapy, and urgent surgical consultation.

Aneurysm of the profunda femoris artery manifested as acute groin pain in a child

Arterial aneurysms in children are extremely rare and can be of congenital, inflammatory, and infectious nature or secondary to trauma. The authors describe the case of a 8-year-old boy who was admitted in the hospital with fever and severe groin pain. He had a true saccular aneurysm of 4 cm in diameter originating from the profunda femoris artery with, according to the clinical and angiographic findings, arteriovenous communication with the femoral veins. Because the aneurysm was firmly adherent to the deep femoral vein, the latter was resected and the venous continuity was restored with a saphenous vein bypass graft. The patient recovered without any complication. The histologic examination showed a normal intimal layer and partially disrupted medial elastic fibers without inflammatory infiltrate, suggesting the diagnosis of a true arterial aneurysm.

[Ruptured mycotic aneurysm with hemoperitoneum: an unusual septic complication of umbilical arterial catheter]

Arterial aneurysms are rare in infants and are usually associated with cardiovascular malformations or connective tissue disorders. Mycotic aneurysms of the aorta or its major branches have been described in newborn infants with septicemia originating from an indwelling umbilical artery catheter. We report a case of a newborn infant with a mycotic aneurysm complicated by massive hemoperitoneum. Surgical treatment allowed a complete recovery. Newborn infants with Staphylococcus aureus bacteremia in the context of a current or recent umbilical artery catheterisation should be followed up closely to detect arterial aneurysms.

Congenital abdominal aortic aneurysm: a case report

Abdominal aortic aneurysm (AAA) is distinctly uncommon in infants and children, and usually results from infection, iatrogenic trauma, vasculitis, connective tissue disorder, or tuberous sclerosis. Congenital "primary" neonatal AAA is exceedingly rare. The few reported cases of repair of congenital AAA describe use of synthetic graft material or aneurysmorrhaphy. We report the first successful treatment of a known 6 cm congenital infrarenal AAA repaired with a 5 mm cryopreserved allograft in a 4-month-old infant girl. The graft was pretreated with an antigen reduction process (SynerGraft), which preliminary studies suggest may inhibit allograft degeneration. The postoperative course was unremarkable. Lower extremity pulses and results of duplex ultrasound flow studies remained excellent at 14-month follow-up. Panel reactive antibodies against class I alloantigens remain negative. The use of an antigen-reduced allograft provides an acceptable conduit, which potentially may decrease allograft degeneration and relative graft stenosis associated with growth of the child, but requires follow-up.