Cardiothoracic and Vascular Surgery Podium Presentation: Ruptured Congenital Abdominal Aortic Aneurysm in an 11-Year-Old with Multiple Peripheral Artery Aneurysms

Introduction/Purpose: Congenital abdominal aortic aneurysms (AAA) are rarely encountered in clinical practice.  The combination of a congenital AAA in a patient with multiple peripheral artery aneurysms is even more rare.  We report the management of an 11-year-old male who presented with a ruptured congenital AAA who also had multiple peripheral arterial aneurysms. 

Methods or Case Description: This 11-year old male collapsed after complaining of severe abdominal pain.  A computed tomography (CT) scan was obtained demonstrating an 11 cm ruptured AAA. He was taken emergently for an exploratory laparotomy.  The retroperitoneal hematoma was evacuated while the supraceliac aorta was compressed.  The proximal aortic aneurysm neck was dissected and the suprarenal aorta was clamped.  The aneurysm was repaired with a bifurcated tube graft.  He survived and recovered well but had a prolonged hospital course secondary to a prolonged ileus.

Outcomes: At 2-month follow up, a CT was obtained that demonstrated the development of new internal iliac artery aneurysms, an axillary and brachial artery aneurysm, and interosseous aneurysms.  These were repaired with coil embolization of the internal iliac aneurysms, and thrombin injection of the interosseous aneurysms.  The axillary artery aneurysms will be surveilled with duplex ultrasonography.

Conclusion: We report an 11-year-old male with no known genetic abnormalities who presented with a ruptured 11 cm AAA which was successfully repaired with an open bifurcated aortic graft.  Additionally, the patient had multiple peripheral artery aneurysms.  The internal iliac artery, left brachial artery, and left ulnar interosseus arteries have all been successfully repaired.  The left axillary artery aneurysm is being closely surveilled.