(PC060) SMA Aneurysms in Pediatric Patients with Congenital Anomalies

Objectives: Visceral artery aneurysms are rare with an incidence of 0.1-2% in the general population. Pediatric visceral arterial aneurysms are even rarer. This report describes two unique cases of symptomatic pediatric superior mesenteric artery (SMA) aneurysms.

Methods: This is a case series of two pediatric patients with symptomatic SMA aneurysms.

Results: A 16-year-old girl with Downs Syndrome and past surgical history of Ventricular Septal Defect (VSD) closure and mitral valve repair as an infant presented with abdominal pain and vomiting. Imaging studies demonstrated a 2x2.6 cm SMA aneurysm with fat stranding around the aneurysm. She was worked up for infectious, traumatic and inflammatory etiologies all of which were negative. The patient underwent an excision of the aneurysm with inline reconstruction using a reversed saphenous vein graft with resolution of her symptoms (Figure 1). The case was notable to dense inflammatory tissue surrounding the aneurysm. The patient had proximal anastomotic stenosis at 3 months follow up and was treated with balloon angioplasty and then stenting. She continues to be free of abdominal symptoms and has patent bypass at 3 months follow up.

The second patient is a 13-year-old boy with a past medical history of cloacal exstrophy with multiple associated corrective procedures leaving the patient with a colostomy and ureteral conduit. He was identified as having a 2.3-2.5 cm aneurysm involving the SMA associated with abdominal pain. He underwent an excision of the aneurysm with reconstruction using a femoral vein graft (Figure 2). Pathology was negative for infectious or inflammatory etiologies of the aneurysm. At 1 year follow up the patient had a patent bypass and no abdominal pain.

In both patients an interrupted end-to-end technique was used. The decision to use saphenous vs femoral vein was based on the quality and diameter of vein available in the patient.

Conclusions: Visceral Artery aneurysms in pediatric patients are unusual and likely to have syndromic association or with other anomalies. Autogenous conduits provide durability and should be the conduit of choice. Special attention to resection of all diseased tissue is important in prevention of long- and short-term complications.