Bell Patrick, Mantor Cameron, Jacocks M Alex
Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma 73190, USA.
J Vasc Surg. 2003 Jul;38(1):190-3. doi: 10.1016/s0741-5214(03)00146-0.
Abdominal aortic aneurysm (AAA) is distinctly uncommon in infants and children, and usually results from infection, iatrogenic trauma, vasculitis, connective tissue disorder, or tuberous sclerosis. Congenital "primary" neonatal AAA is exceedingly rare. The few reported cases of repair of congenital AAA describe use of synthetic graft material or aneurysmorrhaphy. We report the first successful treatment of a known 6 cm congenital infrarenal AAA repaired with a 5 mm cryopreserved allograft in a 4-month-old infant girl. The graft was pretreated with an antigen reduction process (SynerGraft), which preliminary studies suggest may inhibit allograft degeneration. The postoperative course was unremarkable. Lower extremity pulses and results of duplex ultrasound flow studies remained excellent at 14-month follow-up. Panel reactive antibodies against class I alloantigens remain negative. The use of an antigen-reduced allograft provides an acceptable conduit, which potentially may decrease allograft degeneration and relative graft stenosis associated with growth of the child, but requires follow-up.
腹主动脉瘤（AAA）在婴儿和儿童中极为罕见，通常由感染、医源性创伤、血管炎、结缔组织疾病或结节性硬化症引起。先天性“原发性”新生儿AAA极其罕见。少数报道的先天性AAA修复病例描述了使用合成移植材料或动脉瘤缝合术。我们报告了首例成功治疗一名已知6厘米先天性肾下AAA的4个月大女婴，采用5毫米冷冻保存同种异体移植物进行修复。该移植物经过抗原减少处理（SynerGraft），初步研究表明这可能抑制同种异体移植物退化。术后过程顺利。在14个月的随访中，下肢脉搏和双功超声血流研究结果仍然良好。针对I类同种异体抗原的群体反应性抗体仍为阴性。使用抗原减少的同种异体移植物提供了一种可接受的管道，这可能会减少与儿童生长相关的同种异体移植物退化和相对移植物狭窄，但需要随访。
