Jonathan L. Eliason, MD, Dawn M

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Presentation transcript:

Surgical treatment of abdominal aortic aneurysms in infancy and early childhood Jonathan L. Eliason, MD, Dawn M. Coleman, MD, Enrique Criado, MD, James C. Stanley, MD Journal of Vascular Surgery Volume 64, Issue 5, Pages 1252-1261 (November 2016) DOI: 10.1016/j.jvs.2016.04.021 Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 1 Infectious infrarenal 2.2-cm abdominal aortic aneurysm (AAA; long arrow) and 1.3-cm right iliac artery aneurysm (short arrow) in a 2-week-old boy associated with umbilical catheterization and sepsis (computed tomography angiography [CTA]). He was treated with an aortounilateral iliac 6-mm expanded polytetrafluoroethylene (ePTFE) bypass after excision of both aneurysms. Journal of Vascular Surgery 2016 64, 1252-1261DOI: (10.1016/j.jvs.2016.04.021) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 2 Central abdominal aortic aneurysm (AAA) in a 4-month-old boy with involvement of the celiac, superior mesenteric (arrow), and both renal arteries (magnetic resonance angiography [MRA]). Acute preoperative dialysis-dependent renal failure complicated the surgical treatment. Postoperative death occurred at 1 month, after aneurysmectomy, thoracoabdominal bypass, and mesenteric and renal revascularizations. Journal of Vascular Surgery 2016 64, 1252-1261DOI: (10.1016/j.jvs.2016.04.021) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 3 Supraceliac 2-cm abdominal aortic aneurysm (AAA) with involvement of the celiac, superior mesenteric, and renal arteries, associated with a focal and nearly complete occlusion (coarctation) of the diaphragmatic aorta in a 6-month-old boy (computed tomography angiography [CTA]). Treatment included resection of the coarcted aortic segment with a primary aortoaortic reanastomosis, open aneurysmorrhaphy, and aortic reimplantation of one of the affected renal arteries, with no progressive aortic dilation during 7 years postoperatively (CTA). Journal of Vascular Surgery 2016 64, 1252-1261DOI: (10.1016/j.jvs.2016.04.021) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 4 Abdominal aortic aneurysm (AAA) with iliac artery involvement in a 13-month-old boy of undetermined etiology (digital subtraction arteriography). Treatment included aneurysmectomy and a 10-mm expanded polytetrafluoroethylene (ePTFE) aortoiliac bypass, with documented graft patency at 2 years (magnetic resonance angiography [MRA]). Journal of Vascular Surgery 2016 64, 1252-1261DOI: (10.1016/j.jvs.2016.04.021) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 5 Supraceliac mycotic abdominal aortic aneurysm (AAA) in a 20-month-old girl secondary to an infected umbilical artery catheter (UAC; computed tomography angiography [CTA]). Treatment included aneurysmectomy and a 12-mm expanded polytetrafluoroethylene (ePTFE) aortoaortic interposition graft (magnetic resonance angiography [MRA]). Journal of Vascular Surgery 2016 64, 1252-1261DOI: (10.1016/j.jvs.2016.04.021) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 6 Pararenal abdominal aortic aneurysm (AAA) occurring distal to an abdominal aortic narrowing (arrow) in a 4-year-old boy with bilateral renal artery stenosis. Initial treatment included patch aortoplasty, closed aneurysmorrhaphy of the aneurysm, and aortic reimplantation of the renal arteries. Journal of Vascular Surgery 2016 64, 1252-1261DOI: (10.1016/j.jvs.2016.04.021) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 7 Central abdominal aortic aneurysm (AAA) with involvement of the celiac, superior mesenteric, and renal arteries associated with tuberous sclerosis in a 5-year-old boy (computed tomography angiography [CTA]). Treatment included aneurysmectomy, 14-mm expanded polytetrafluoroethylene (ePTFE) thoracoabdominal bypass, aortic reimplantation of a left renal artery and superior mesenteric artery (SMA), and aortoceliac bypass with a hypogastric artery graft, all from the distal abdominal aorta (arrow), as well as a right nephrectomy (digital subtraction arteriography). Journal of Vascular Surgery 2016 64, 1252-1261DOI: (10.1016/j.jvs.2016.04.021) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 8 Eccentric pararenal abdominal aortic aneurysm (AAA; arrows) arising from the lateral aortic wall (computed tomography) in a 5-year-old boy. Treatment involved an aneurysmectomy with a primary aortoplastic closure of the aortic wall (magnetic resonance angiography [MRA]). Journal of Vascular Surgery 2016 64, 1252-1261DOI: (10.1016/j.jvs.2016.04.021) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 9 Pararenal abdominal aortic aneurysm (AAA) with bilateral renal artery stenoses and the superior mesenteric artery (SMA) origin (computed tomography angiography [CTA], posterior view in a 5-year-old boy). Treatment involved a 14-mm expanded polytetrafluoroethylene (ePTFE) thoracoabdominal bypass from the supraceliac aorta to the infrarenal aorta (digital subtraction arteriography), with implantations of the SMA to the proximal aorta (short arrow) and renal arteries into the distal aorta (long arrow). Journal of Vascular Surgery 2016 64, 1252-1261DOI: (10.1016/j.jvs.2016.04.021) Copyright © 2016 Society for Vascular Surgery Terms and Conditions