Pediatric splanchnic arterial occlusive disease: clinical relevance and operative treatment.
OBJECTIVE
Splanchnic arterial occlusive disease is rare in childhood. The purpose of this study was to review the clinical relevance and operative treatment of these lesions in a unique experience from a single institution.


METHODS
Seventeen children (11 boys and 6 girls) from 2 years to 17 years in age with critical narrowings of the celiac artery (CA) and superior mesenteric artery (SMA) underwent treatment at the University of Michigan from 1974 to 2000. Etiologic factors included embryologic fusion abnormalities of the fetal aortae during formation of the splanchnic arteries (n = 15), inflammatory aortoarteritis (n = 1), and radiation-induced arterial fibrosis (n = 1). Individual lesions included CA occlusions (n = 6) and stenoses (n = 7), SMA occlusions (n = 3) and stenoses (n = 11), and inferior mesenteric artery stenosis (n = 1). Fourteen children had abdominal aortic coarctations, and 15 had renal artery stenoses. Two patients had postprandial abdominal discomfort and food aversion, consistent with intestinal angina. Small stature affected five others, perhaps attributable to severe renovascular hypertension and failure to thrive. Ten children underwent intestinal revascularization, at the time of an aortoplasty or thoracoabdominal bypass for aortic coarctation (n = 7) or at the time of renal artery revascularization (n = 8). Primary splanchnic revascularization procedures included SMA-aortic implantation (n = 3), aorto-SMA and CA bypass with an internal iliac artery graft (n = 3) or a saphenous vein graft (n = 1), CA-aortic implantation at a stenotic SMA origin (n = 2), and CA and SMA intimectomy (n = 1). Secondary operations included SMA-aortic implantation (n = 2).


RESULTS
All 10 children who underwent splanchnic revascularization have thrived, gained weight, and are free of abdominal pain, with follow-up periods averaging 9 years. No intestinal ischemic manifestations occurred in the seven children who did not undergo operation.


CONCLUSIONS
Pediatric splanchnic arterial occlusive disease is a rare illness appropriately treated with operation in properly selected children.
Upchurch
Gilbert R
GR
Section of Vascular Surgery, Department of Surgery, University of Michigan Hospital, 1500 E. Medical Center Drive, 2210THCC, Ann Arbor, MI 48109-0329, USA. riversu@umich.edu
Henke
Peter K
PK
Eagleton
Matthew J
MJ
Grigoryants
Vladimir
V
Sullivan
Vita V
VV
Wakefield
Thomas W
TW
Jacobs
Lloyd A
LA
Greenfield
Lazar J
LJ
Stanley
James C
JC
D000293:Adolescent; D000367:Age Factors; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D002445:Celiac Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D013152:Splanchnic Circulation / Q000502:physiology; D014656:Vascular Surgical Procedures