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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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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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3
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İriz E, Tak S, Yiğiter EN, Leventoğlu E, Demirtaş H, Akkuzu E, Uysal Yazıcı M, Fidan K, Dalgıç A. A rare cause and an even rarer treatment of hypertension in a 5-year-old boy: Mid-aortic syndrome. Nephrology (Carlton) 2024; 29:230-234. [PMID: 38109884 DOI: 10.1111/nep.14262] [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] [Received: 09/17/2023] [Revised: 11/10/2023] [Accepted: 12/01/2023] [Indexed: 12/20/2023]
Abstract
Renal artery stenosis is one of the common vascular diseases that cause hypertension in children. However, renal artery aneurysms and abdominal aortic aneurysms, which may be components of mid-aortic syndrome, are rarely associated with renal artery stenosis. Despite its rarity, early diagnosis and treatment are critical to prevent fatal complications. Currently, non-surgical invasive techniques are considered the first choice for treatment, but in some cases, surgery is inevitable. Here, we present a 5-year-old boy with a mid-aortic syndrome. The patient presented with a history of severe headache and epistaxis 5-6 times a day and was diagnosed with hypertension. A 9 × 9 mm saccular aneurysm on the anterior surface of the abdominal aorta at the level of the left renal artery ostium, and a 12 mm aneurysm in the left renal artery after a stenotic segment at the hilum level was detected in the doppler USG and contrast-enhanced imaging techniques. The patient was operated on electively. We used a PTFE patch to repair the abdominal aorta and, saphenous vein which was taken from his father to repair the renal artery. The patient recovered well and was discharged on the 18th day.
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Affiliation(s)
- Erkan İriz
- Faculty of Medicine, Department of Cardiovascular Surgery, Gazi University, Ankara, Turkey
| | - Sercan Tak
- Faculty of Medicine, Department of Cardiovascular Surgery, Gazi University, Ankara, Turkey
| | - Eda Nur Yiğiter
- Faculty of Medicine, Department of Cardiovascular Surgery, Gazi University, Ankara, Turkey
| | - Emre Leventoğlu
- Faculty of Medicine, Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
| | - Hüseyin Demirtaş
- Faculty of Medicine, Department of Cardiovascular Surgery, Gazi University, Ankara, Turkey
| | - Emine Akkuzu
- Faculty of Medicine, Department of Pediatric Intensive Care, Gazi University, Ankara, Turkey
| | - Mutlu Uysal Yazıcı
- Faculty of Medicine, Department of Pediatric Intensive Care, Gazi University, Ankara, Turkey
| | - Kibriya Fidan
- Faculty of Medicine, Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
| | - Aydın Dalgıç
- Faculty of Medicine, Department of General Surgery, Gazi University, Ankara, Turkey
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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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Warner D, Holmes KW, Afifi R, Russo ML, Shalhub S. Emergency vascular surgical care in populations with unique physiologic characteristics: Pediatric, pregnant, and frail populations. Semin Vasc Surg 2023; 36:340-354. [PMID: 37330246 DOI: 10.1053/j.semvascsurg.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 06/19/2023]
Abstract
Vascular surgical emergencies are common in vascular surgical care and require complex decision making and multidisciplinary care. They are especially challenging when they occur in patients with unique physiological characteristics, such as pediatric, pregnant, and frail patients. Among the pediatric and pregnant population, vascular emergencies are rare. This rarity challenges accurate and timely diagnosis of the vascular emergency. This landscape review summarizes these three unique populations' epidemiology and emergency vascular considerations. Understanding the epidemiology is the foundation for accurate diagnosis and subsequent management. Considering each population's unique characteristics is crucial to the emergent vascular surgical interventions decision making. Collaborative and multidisciplinary care is vital in gaining expertise in managing these special populations and achieving optimal patient outcomes.
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Affiliation(s)
- David Warner
- Division of Vascular and Endovascular Surgery, Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code OP11, Portland, OR 97239
| | - Kathryn W Holmes
- Division of Cardiology, Department of Pediatrics, Oregon Health and Science University, Portland, OR
| | - Rana Afifi
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX
| | - Melissa L Russo
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital, Providence, RI; Warren Alpert Medical School of Brown University, Providence, RI
| | - Sherene Shalhub
- Division of Vascular and Endovascular Surgery, Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code OP11, Portland, OR 97239.
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6
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Tangsiwong T, Tangsriwong T. Misinterpretation of a giant idiopathic concealed right iliac artery aneurysm as infantile pelvic tumor imaged by non-angiographic computed tomography: a case report. ANNALS OF PEDIATRIC SURGERY 2023. [DOI: 10.1186/s43159-023-00246-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023] Open
Abstract
Abstract
Background
Idiopathic pediatric artery aneurysm is extremely rare and sometimes behaves like a pelvic neoplasm. As it is associated with a high mortality while ruptured, the accurate diagnosis is indispensable to avoid life-threatening complications. Angiographic imaging is the gold standard for diagnosis and treatment planning of the aneurysm. Due to the considerably higher radiation sensitivity of children, single portal venous-phase scanning of the abdominopelvic computed tomography (CT) is, however, reasonably utilized for the evaluation of a clinically palpable mass; the erroneous diagnosis of such aneurysm can be feasible.
Case presentation
A giant idiopathic concealed right iliac artery aneurysm in a 47-day-old girl presented with a palpable pelvic mass regardless of unidentifiable predisposing factors. Non-angiographic abdominopelvic CT was reappraised by the radiology consultant according to discordance between the mass characteristics on initial CT report and those on second-look sonography, revealing the concealed aneurysm instead of solid neoplasm as it originated from right internal iliac artery. The patient underwent an emergency laparotomy with successful proximal ligation of right internal iliac artery despite intraoperative aneurysmal rupture.
Conclusions
Typical CT features for the infantile iliac artery aneurysms may be overlooked, especially if the angiographic phase is omitted; thus, the imaging characteristics of the aneurysms are more difficult to appreciate and can mimic a pelvic neoplasm. Therefore, the identification of the origin of the mass should be more practical to achieve the precise diagnosis.
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7
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Neri CR, Torresi S, Chiavaroli V, Coclite E, Galasso D, Brancaccio G, Trezzi M, Fusaro F, Bagolan P, Chiarelli F, Di Valerio S. A neonatal report of iliac artery aneurysm. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2023. [DOI: 10.1016/j.epsc.2023.102593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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8
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Chikada M, Chiba K, Nawata K, Tomita M, Nakamura R, Kinebuchi S, Kita S, Komagamine M, Kogo M, Nishimaki H, Miyairi T. Longterm Followup of a Pediatric Patient with Congenital Abdominal Aortic Aneurysm with Coarctation. Ann Vasc Dis 2022; 15:341-343. [PMID: 36644269 PMCID: PMC9816021 DOI: 10.3400/avd.cr.22-00067] [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: 06/08/2022] [Accepted: 08/27/2022] [Indexed: 11/05/2022] Open
Abstract
Congenital abdominal aortic aneurysm (AAA) with coarctation has been considered an extremely rare condition. In this study, we present a 3-year-old boy, who was diagnosed by chance with congenital AAA at first operation. We replaced the AAA+coarctation with a 6-mm polytetrafluoroethylene (PTFE) graft. Histological examination of the aortic wall revealed no particular abnormalities. Collateral vessels were noted to develop over 14 years of followup. Good blood flow to both lower limbs and no intermittent claudication were observed. After growth, at the age 17, he underwent extra-anatomical bypass using a 12-mm PTFE graft. This is the first report of successful treatment of congenital AAA+coarctation with longterm followup.
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Affiliation(s)
- Masahide Chikada
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan,Corresponding author: Masahide Chikada, MD. Department of Cardiovascular Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan Tel: +81-44-977-8111, Fax: +81-44-976-5792, E-mail:
| | - Kiyoshi Chiba
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Kan Nawata
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Masahiro Tomita
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Ryuji Nakamura
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Satoshi Kinebuchi
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Shota Kita
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Masahide Komagamine
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Misa Kogo
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hiroshi Nishimaki
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Takeshi Miyairi
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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9
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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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10
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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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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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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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13
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Tanga CF, Fakhoury E, Ham PB, Dosluoglu HH, Harris LM. Ruptured abdominal aortic aneurysm in an 11-year-old with multiple peripheral artery aneurysms. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:539-542. [PMID: 33134637 PMCID: PMC7588751 DOI: 10.1016/j.jvscit.2020.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/23/2020] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
| | - Elias Fakhoury
- Department of Vascular Surgery, University at Buffalo, Buffalo, NY
| | - P Benson Ham
- Department of Vascular Surgery, University at Buffalo, Buffalo, NY
| | | | - Linda M Harris
- Department of Vascular Surgery, University at Buffalo, Buffalo, NY
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14
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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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15
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Higuchi K, Furukawa K, Nakamura E, Imamura H, Gi T, Nakamura K. Congenital Abdominal Aortic Aneurysm in a Four Year Old Girl. EJVES Vasc Forum 2020; 48:12-18. [PMID: 33078163 PMCID: PMC7327408 DOI: 10.1016/j.ejvsvf.2020.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/12/2020] [Accepted: 05/11/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Abdominal aortic aneurysm (AAA) in neonates, infants, and children is uncommon, usually occurring as a result of infections, connective tissue disorders, vasculitis, or iatrogenic trauma. A case of idiopathic congenital AAA, an extremely rare disease of unknown origin, is described. Report In March 2018, a 40 mm hypoechoic mass adjacent to the left kidney was detected incidentally by abdominal ultrasound for investigation of hypercalciuria in a four year old girl. Contrast enhanced computed tomography (CT) revealed an infrarenal fusiform AAA measuring 39 mm in maximum diameter, a 15 mm left renal artery aneurysm, a 14 mm right hypogastric artery aneurysm, and a 12 mm left hypogastric artery aneurysm. Cerebral magnetic resonance imaging revealed multiple intracranial aneurysms between 8 and 15 mm in diameter. Considering the size of the AAA and risk of rupture, surgical repair was planned. In May 2018, the congenital AAA was successfully repaired with a 10 mm Dacron aorto-aortic tube graft. Increases in the size of the left renal artery aneurysm and a left middle meningeal artery aneurysm were detected 12 and 14 months post-operatively, respectively. Coil embolisations were performed. An intracranial dural arteriovenous fistula (AVF) was discovered incidentally by cerebral angiography for treatment of the left middle meningeal artery aneurysm. Transarterial embolisation for AVF was also performed. At the 21 month post-operative follow up, the patient is doing well, and the untreated aneurysms have not grown. Conclusion Long term outcomes after surgical repair for congenital AAA are unclear. Moreover, growth of residual aneurysms was detected post-operatively, so follow up with frequent multimodality imaging for multiple aneurysms is necessary.
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Affiliation(s)
- Kazuhiro Higuchi
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki City, Japan.,Department of Cardiovascular Surgery, Miyazaki Medical Association Hospital, Miyazaki City, Japan
| | - Koji Furukawa
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki City, Japan
| | - Eisaku Nakamura
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki City, Japan
| | - Hideaki Imamura
- Division of Paediatrics, Department of Developmental and Urological-Reproductive Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki City, Japan
| | - Toshihiro Gi
- Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki City, Japan
| | - Kunihide Nakamura
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki City, Japan
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16
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Wang MX, Baxi A, Rajderkar D. Pictorial review of non-traumatic thoracic emergencies in the pediatric population. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0012-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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17
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Ng R, Eliezer D, Vilain R, Kamien B, Deshpande AV. Fatal Exsanguination Following Rupture of an Iliac Artery Aneurysm in an Infant With Menkes Disease. Pediatr Dev Pathol 2019; 22:486-491. [PMID: 30935272 DOI: 10.1177/1093526619841152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Menkes disease (MD) usually presents in infancy with respiratory and neurological complications. Severe isolated vasculo-connective tissue involvement in infancy is rare, and hence the precise and timely diagnosis is difficult. We report a case of an 8-week-old male infant who succumbed to acute, severe exsanguination, and hemorrhagic shock secondary to a large retroperitoneal hematoma due to rupture of a right iliac artery aneurysm. Perimortem musculoskeletal findings raised suspicion of nonaccidental injury. However, postmortem review of facial traits raised the suspicion of MD. MD was subsequently confirmed on genetic testing. Child health clinicians must remain aware of MD as a rare cause of infant vasculopathy or atypical skeletal abnormalities.
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Affiliation(s)
- Rachel Ng
- Department of Paediatric Surgery, John Hunter Children's Hospital, Newcastle, Australia
| | - Dilharan Eliezer
- Department of Paediatric Surgery, John Hunter Children's Hospital, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Ricardo Vilain
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- Pathology North - Hunter, NSW Health Pathology, Newcastle, Australia
| | - Benjamin Kamien
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- Hunter Genetics, Waratah, Australia
| | - Aniruddh V Deshpande
- Department of Paediatric Surgery, John Hunter Children's Hospital, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- Priority Research Centre GrowUpWell, University of Newcastle, Newcastle, Australia
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18
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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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19
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Surgery on a dilated aorta associated with a connective tissue disease or inflammatory vasculitis in children and adolescents. Cardiol Young 2019; 29:564-569. [PMID: 31111802 DOI: 10.1017/s1047951118002299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION This research investigated patients who underwent surgery for a dilated aorta associated with a connective tissue disease or inflammatory vasculitis in children and adolescents. MATERIALS AND METHODS The medical records of 11 patients who underwent aortic surgery for dilatation resulting from a connective tissue disease or inflammatory vasculitis between 2000 and 2017 were retrospectively reviewed. RESULTS The median age and body weight of the patients were 9.6 years (range 5.4 months-15.5 years) and 25.8 kg (range 6.8-81.5), respectively. The associated diseases were Marfan syndrome (n = 3), Loeys-Dietz syndrome (n = 3), Kawasaki disease (n = 1), Takayasu arteritis (n = 1), PHACE syndrome (n = 1), tuberous sclerosis (n = 1), and unknown (n = 1). The most common initially affected area was the ascending aorta. During the 66.4 ± 35.9 months of follow-up, two Marfan syndrome patients died, and four patients (one Marfan syndrome and three Loeys-Dietz syndrome) had repeated aortic operation. Except for one patient, the functional class was well maintained in all patients who were followed up. CONCLUSION Cases of surgical treatment for a dilated aorta associated with a connective tissue disease and inflammatory vasculitis are rare in children and adolescents at our institution. Most of the patients in this study showed a tolerable postoperative course. However, the aorta showed progressive dilation over time even after surgical treatment, especially in patients with Loeys-Dietz syndrome. In these patients, close and more frequent regular follow-up is required.
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20
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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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21
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Giant Aneurysm of the Ascending Aorta Requiring Emergency Repair in a Newborn Baby. Ann Thorac Surg 2018; 107:e107-e109. [PMID: 30118715 DOI: 10.1016/j.athoracsur.2018.06.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 11/21/2022]
Abstract
Congenital aneurysm of the ascending aorta is a rare cardiovascular pathology and usually associated with well-known connective tissue disorders. We present an idiopathic ascending aortic aneurysm extending to the aortic arch in an antenatally diagnosed newborn who required immediate surgical treatment due to the rapid progression of aneurysm size at the age of 1 day.
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22
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Medical conditions mimicking the acute surgical abdomen in children. ANNALS OF PEDIATRIC SURGERY 2018. [DOI: 10.1097/01.xps.0000530172.14328.f9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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23
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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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24
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Sainathan S, Monge M, Eltayeb O. Successful Repair of a Ruptured Mycotic Aortic Aneurysm in a Pediatric Patient with Deep Hypothermic Circulatory Arrest. Am Surg 2018. [DOI: 10.1177/000313481808400214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Sandeep Sainathan
- Department of Pediatric Cardiothoracic Surgery Ann and Robert H. Lurie Children's Hospital of Chicago/Northwestern University Chicago, Illinois
| | - Michael Monge
- Department of Pediatric Cardiothoracic Surgery Ann and Robert H. Lurie Children's Hospital of Chicago/Northwestern University Chicago, Illinois
| | - Osama Eltayeb
- Department of Pediatric Cardiothoracic Surgery Ann and Robert H. Lurie Children's Hospital of Chicago/Northwestern University Chicago, Illinois
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25
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Kuboi T, Miyagi M, Kondo S, Arioka M, Yamato S, Sadamura T, Jinnai W, Nakano A, Ota A. Congenital abdominal aortic aneurysm discovered incidental to a lower back mass. Pediatr Int 2018; 60:98-99. [PMID: 29356288 DOI: 10.1111/ped.13458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/07/2017] [Accepted: 10/10/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Toru Kuboi
- Departments of Neonatology, Shikoku Medical Center for Children and Adults, Kagawa, Japan
| | - Megumi Miyagi
- Departments of Neonatology, Shikoku Medical Center for Children and Adults, Kagawa, Japan
| | - Shuji Kondo
- Department of Pediatrics, Shikoku Medical Center for Children and Adults, Kagawa, Japan
| | - Makoto Arioka
- Departments of Neonatology, Shikoku Medical Center for Children and Adults, Kagawa, Japan
| | - Satoshi Yamato
- Departments of Neonatology, Shikoku Medical Center for Children and Adults, Kagawa, Japan
| | - Takaaki Sadamura
- Departments of Neonatology, Shikoku Medical Center for Children and Adults, Kagawa, Japan
| | - Wataru Jinnai
- Departments of Neonatology, Shikoku Medical Center for Children and Adults, Kagawa, Japan
| | - Akiko Nakano
- Departments of Neonatology, Shikoku Medical Center for Children and Adults, Kagawa, Japan
| | - Akira Ota
- Departments of Neonatology, Shikoku Medical Center for Children and Adults, Kagawa, Japan
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Bansal A, Mitra A, Bisoi AK, Agarwala S. Surgical Repair of Congenital Abdominal Aortic Aneurysm in a 1-year-old Child with Literature Review. J Indian Assoc Pediatr Surg 2017; 22:176-178. [PMID: 28694579 PMCID: PMC5473308 DOI: 10.4103/jiaps.jiaps_258_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Reported here is a case of 1-year-old male child who presented with huge abdominal mass, which on radiological investigation was diagnosed as retroperitoneal pseudoaneurysm of the aorta. On exploration, it was found to be a true aneurysm of infrarenal abdominal aorta with inflow agenesis. Aneurysm was excised, and aorta was reconstructed with 10 mm Dacron graft. Postoperative computed tomography angiography showed patent graft with good distal runoff. Literature review revealed that only 26 cases of congenital abdominal aortic aneurysm had been reported so far. None of them had inflow agenesis which can give false impression of pseudoaneurysm on preoperative evaluation. The case highlights the utility of additional complimentary investigations such as Doppler study in clinching diagnosis and helping plan and execute successful treatment in the difficult diagnostic scenario.
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Affiliation(s)
- Ashwani Bansal
- Department of Cardio-thoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Aparajita Mitra
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Akshay Kumar Bisoi
- Department of Cardio-thoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Agarwala
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
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Comparison of Efficacy of Endovascular Aneurysm Repair Versus Open Surgical Repair in Middle/High-Risk Patients With Abdominal Aortic Aneurysm. Am J Ther 2015; 23:e37-43. [PMID: 26295612 DOI: 10.1097/mjt.0000000000000289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To explore the efficacy of endovascular aneurysm repair (EVAR) compared with traditional open surgical repair (OSR) in the treatment of middle/high-risk patients with abdominal aortic aneurysm (AAA). With a retrospective method, we analyzed the clinical data of 57 patients with middle/high-risk AAA admitted to Linyi People's Hospital Affiliated to Shandong University from January 2010 to January 2014. Twenty-eight of the 57 patients received EVAR and 29 others received OSR. Statistical analysis was conducted by the design of spreadsheet according to preoperative, intraoperative, perioperative, and postoperative follow-up relevant information. Our study showed that the difference in baseline characteristics of different therapies in middle/high-risk AAA patients was not statistically significant in preoperative period (P > 0.05). In intraoperative period, the efficacy of middle/high-risk AAA patients in EVAR group was significantly superior to OSR group in terms of blood loss, blood transfusion, and general anesthesia rate (all P < 0.01). In perioperative period, the ICU observation time and the average fasting time of middle/high-risk AAA patients in EVAR group were remarkably lower than OSR group (all P < 0.01), but the average hospital stay and the operation cost of middle/high-risk AAA patients in EVAR group were notably higher than OSR group. In postoperative follow-up period, OSR group was identified with a lower incidence of surgery-related complications than EVAR group (P < 0.05), but EVAR group was demonstrated with a higher survival rate than OSR group (P < 0.05); after 12 months of follow-up, SF-36 scale scores in OSR group were higher than EVAR group (P < 0.05). In conclusion, EVAR may have a better short-term effect, whereas OSR may have a better long-term effect in the treatment of middle/high-risk AAA patients.
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