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

Abstract

BackgroundCongenital abdominal aortic aneurysm (AAA) is distinctly rare in infants and children and carries a high mortality rate. Our objective was to summarize the experience of the diagnosis and treatment in patients with congenital AAA.MethodsReported cases of congenital AAA published prior to November 8, 2014, were identified through PubMed, EMBASE, Web of Science, and reference lists. All selected cases were evaluated for main clinical characteristics.ResultsTwenty-six cases of congenital AAA were identified in the English language literature. Congenital AAA occurred primarily in children under three years old, but it was also found in young adults and fetuses. With regards to the localization, the great majority of congenital AAA was infrarenal AAA. The majority of the AAA patients lacked specific symptoms, and a painless pulsatile abdominal mass was the most common clinical presentation. The diagnosis of AAA was based on ultrasound scanning in twenty-five cases, multi-slice spiral computed tomography angiography (MSCTA) in sixteen cases, and magnetic resonance angiography (MRA) in nine cases. Histopathological analyses were available in seven cases. Seven patients received conservative management. Surgical treatment was performed in seventeen cases, and open repair with an artificial graft was the main surgical intervention. The mortality associated with congenital AAA was high (30.76%). Ruptured aneurysm and renal failure were the main causes of death.ConclusionsGood outcomes can be achieved in children with early identification of congenital AAA and individualized surgical repair with grafts.

Congenital abdominal aortic aneurysm discovered incidental to a lower back mass

“…For diagnosis, congenital AAA must be distinguished from acquired AAA resulting from conditions such as connective tissue disease, traumatic injury, and vasculitis. In the present case, there were no findings or family history of Marfan, Ehlers–Danlos, or Loeys–Dietz syndrome . Development of genetic testing for these diseases is currently in progress.…”

“…Congenital AAA is extremely rare and has a high mortality rate due to rupture or renal failure . Clinical presentation varies from rupture to no symptoms.…”

Comparison of Efficacy of Endovascular Aneurysm Repair Versus Open Surgical Repair in Middle/High-Risk Patients With Abdominal Aortic Aneurysm

“…AAA was diagnosed in accordance with the following criteria: the pathologic local dilatation of the abdominal aorta was more than 30 mm or the size of the pathologic local dilatation was beyond 50% of the size of the abdominal aorta. 2 The inclusion criteria of patients were as follows: (1) be in line with anatomic endovascular treatment standards and suitable for surgery; (2) aged 41-91 years with tumor diameter $4.0 cm; (3) nonruptured infrarenal AAA; and (4) aneurysm neck .1.5 cm and suitable for skeletal anatomy. The exclusion criteria were as follows: (1) ruptured AAA or have symptoms require emergency surgery; (2) aneurysm neck ,1.5 cm and not suitable for skeletal anatomy; (3) anatomy mutants; (4) with a history of multiple abdominal surgeries; (5) cancer, transplantation, active infection, and connective tissue patients; (6) with myocardial infarction and angina pectoris ,3 months, or with unstable angina pectoris; and (7) with severe valvular disease or severe arrhythmia.…”

Pictorial review of non-traumatic thoracic emergencies in the pediatric population

“…Management largely follows the literature for adults due to limited studies in congenital aortic aneurysms: conservative management or surgical repair. There is presently no definite size criteria for surgical repair [26]. In the event of a rupture, the patient requires emergent intervention as mortality reaches 80%.…”