Moreno-Urías Marian D, Anaya-Ayala Javier E, Celis-Jiménez Alejandro
Facultad de Medicina, Universidad Autónoma de Guadalajara, Jalisco, Mexico.
Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
EJVES Vasc Forum. 2025 Apr 19;64:16-19. doi: 10.1016/j.ejvsvf.2025.04.005. eCollection 2025.
Kawasaki disease is an acute, self limited vasculitis that predominantly affects children under five years of age. It is clinically diagnosed by persistent fever for at least five days along with four of the main clinical features. Bilateral upper limb aneurysms are rare in Kawasaki disease, with limited literature comprising case reports and small series, leaving management guidelines unclear.
This study presents the case of a three year old male with a history of incomplete Kawasaki disease at eight months of age. Initial treatment included two doses of gammaglobulin after which he was diagnosed with aneurysms in both the left and right coronary arteries; he remained in a stable condition under bi-annual monitoring. Six months later, the patient was referred having developed aneurysms in the left axillary and right brachial arteries. Open and endovascular approaches were discussed with his parents; endovascular management was opted for. Covered stents (6 x 56 mm and 8 x 56 mm Fluency Plus Endovascular Stent Graft, Becton Dickinson & Co., New Jersey, USA) were successfully placed in the left axillary and right brachial arteries during a single procedure. The patient remained haemodynamically stable and was discharged 24 hours post-operation without complications. At the 24 month follow up, the patient was asymptomatic, and ultrasound confirmed the continued patency of the stents.
This case highlights the importance of individualised treatment strategies for paediatric patients with Kawasaki disease complicated by arterial aneurysms. The use of stent grafts in children presents unique challenges, including long-term durability, vessel growth, and thrombosis risk, necessitating careful patient selection and lifelong follow up. The successful outcome observed in this case highlights the potential of endovascular techniques as a viable alternative to open surgery, emphasising the need for further studies to establish standardised guidelines for paediatric vascular interventions.
川崎病是一种急性自限性血管炎，主要影响五岁以下儿童。临床上通过持续发热至少五天以及四项主要临床特征进行诊断。双侧上肢动脉瘤在川崎病中较为罕见，相关文献有限，多为病例报告和小样本系列研究，使得治疗指南尚不明确。
本研究呈现了一名三岁男性病例，该患儿八个月大时曾患不完全川崎病。初始治疗包括两剂丙种球蛋白，之后被诊断出左右冠状动脉均有动脉瘤；在每半年一次的监测下，他的病情保持稳定。六个月后，该患者因左腋动脉和右肱动脉出现动脉瘤前来就诊。与患儿家长讨论了开放手术和血管内治疗方法；最终选择了血管内治疗。在一次手术中，成功地将覆膜支架（6×56毫米和8×56毫米Fluency Plus血管内支架移植物，美国新泽西州BD公司）置入左腋动脉和右肱动脉。患者血流动力学保持稳定，术后24小时出院，无并发症。在24个月的随访中，患者无症状，超声检查证实支架持续通畅。
本病例突出了针对合并动脉动脉瘤的川崎病患儿采取个体化治疗策略的重要性。在儿童中使用支架移植物存在独特挑战，包括长期耐用性、血管生长和血栓形成风险，因此需要仔细选择患者并进行终身随访。本病例观察到的成功结果突出了血管内技术作为开放手术可行替代方案的潜力，强调需要进一步研究以建立儿科血管介入的标准化指南。
