Microsurgical and Endovascular Management of Congenital Iliac Aneurysms in the Neonatal Period: Two Cases and a Literature Review

Hari Iyer; Shahrzad Joharifard; Annie Le-Nguyen; Josée Dubois; Rafik Ghali; Daniel E Borsuk; Michel Lallier

doi:10.1016/j.ejvsvf.2021.06.007

Microsurgical and Endovascular Management of Congenital Iliac Aneurysms in the Neonatal Period: Two Cases and a Literature Review

EJVES Vasc Forum. 2021 Jun 21:52:41-48. doi: 10.1016/j.ejvsvf.2021.06.007. eCollection 2021.

Authors

Hari Iyer¹, Shahrzad Joharifard², Annie Le-Nguyen³, Josée Dubois⁴, Rafik Ghali⁵, Daniel E Borsuk¹, Michel Lallier²

Affiliations

¹ Department of Surgery, Division of Plastic & Reconstructive Surgery, Université de Montréal, Montréal, Québec, Canada.
² Department of Surgery, Division of Paediatric Surgery, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada.
³ Department of Surgery, Division of General Surgery, Université de Montréal, Montréal, Québec, Canada.
⁴ Department of Radiology, Radiation-Oncology and Nuclear Medicine, Division of Paediatric Interventional Radiology, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada.
⁵ Department of Surgery, Division of Vascular Surgery, Hôpital Maisonneuve-Rosemont, Montreal, Québec, Canada.

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.

Keywords: Abdominal; Congenital abnormalities; Endovascular procedures; Iliac aneurysm; Microsurgery; Newborn.

Publication types

Review