Document Detail

Extra-anatomic bypass for recurrent abdominal aortic and renal in-stent stenoses following radiotherapy for neuroblastoma.
MedLine Citation:
PMID:  19126553     Owner:  NLM     Status:  MEDLINE    
We describe the case of an 11-year-old girl with an abdominal neuroblastoma which was operated and intraoperatively irradiated nine years ago. After six years, she developed stenoses of the infrarenal abdominal aorta and both renal arteries. Initial treatment of the stenosed vessels comprised endovascular balloon dilatations and repeated stent-graft implantations, including drug eluting stents. However, severe in-stent stenoses occurred during follow-up and the girl developed acute renal failure. Open surgery was performed with two extra-anatomic bypasses, a thoracic-to-abdominal aortic bypass and a left iliac-to-renal bypass, on an urgent basis. The postoperative course was uneventful and the patient was discharged home two weeks after the operation with full recovery of renal function. We conclude that endovascular stent-graft placement in children can only be a palliative treatment due to outgrowing of the stent-graft and the potential risk of re-stenosis, especially after a history of irradiation. Vascular surgery with placement of extra-anatomic bypasses will provide a definite treatment.
Maximilian Luehr; Matthias Siepe; Friedhelm Beyersdorf; Christian Schlensak
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2009-01-06
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  8     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-03-23     Completed Date:  2009-06-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  488-90     Citation Subset:  IM    
Department of Cardiovascular Surgery, University Medical Center Freiburg, Freiburg, Germany.
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MeSH Terms
Abdominal Neoplasms / radiotherapy*,  surgery
Angiography, Digital Subtraction
Angioplasty, Balloon / instrumentation*
Aorta, Abdominal / radiography,  surgery*
Aorta, Thoracic / surgery
Aortic Diseases / etiology,  radiography,  surgery,  therapy*
Aortography / methods
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation* / instrumentation
Constriction, Pathologic
Drug-Eluting Stents*
Iliac Artery / surgery
Kidney Failure, Acute / etiology,  surgery
Neuroblastoma / radiotherapy*,  surgery
Palliative Care
Radiation Injuries / etiology,  radiography,  surgery,  therapy*
Radiotherapy / adverse effects
Renal Artery Obstruction / etiology,  radiography,  surgery,  therapy*
Tomography, X-Ray Computed
Treatment Outcome

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