title: Extra-anatomic bypass for recurrent abdominal aortic and renal in-stent stenoses following radiotherapy for neuroblastoma.
abstract: 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.
authors.affiliation: Department of Cardiovascular Surgery, University Medical Center Freiburg, Freiburg, Germany. mail@dr-luehr.net
authors.forename: Maximilian
authors.initials: M
authors.lastname: Luehr
authors.forename: Matthias
authors.initials: M
authors.lastname: Siepe
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Beyersdorf
authors.forename: Christian
authors.initials: C
authors.lastname: Schlensak
mesh_terms: D000008:Abdominal Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D058186:Acute Kidney Injury / Q000209:etiology / Q000601:surgery; D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon / Q000295:instrumentation*; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D002648:Child; D003251:Constriction, Pathologic; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D009447:Neuroblastoma / Q000532:radiotherapy* / Q000601:surgery; D010166:Palliative Care; D011832:Radiation Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D011878:Radiotherapy / Q000009:adverse effects; D012008:Recurrence; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome