Southern Association For Vascular Surgery

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Ligation of Common Iliac Artery Mycotic Aneurysm in a Neonate and Review of the Literature
Benjamin C Powell, Keith Webb, Brian Freeman, Christopher Carsten, Sagar Gandhi
Greenville Health System, Greenville, SC

INTRODUCTION: Aortoiliac mycotic aneurysms in the neonate are rare. Surgical treatment has traditionally been the standard of care, but recent case reports have suggested that endovascular management of mycotic iliac aneurysms may also be safe and effective. In this case, we describe successful management of an aortoiliac mycotic aneurysm in a neonate with exploratory laparotomy and ligation of the left common iliac artery.
METHODS: A full-term infant boy of uncomplicated delivery was transferred to our institution on day of life (DoL) 2 following a barium enema concerning for small left colon syndrome. An umbilical artery catheter had been placed for monitoring but was removed prior to transfer. During his hospital course he developed left leg edema and fever and was found to have mycotic aneurysms of the left common and internal iliac arteries causing common iliac venous compression. The aneurysm expanded to a maximum of 12mm in diameter and 26 mm in length on repeat ultrasound.
RESULTS: Treatment was delayed until the patient was clinically stable. He was monitored with serial ultrasound, which showed no significant increase in aneurysmal size. After review of the literature, it was felt that this aneurysm posed an impending risk to the patient. On DoL16, the neonate underwent ligation and excision of the left common iliac artery aneurysm.
CONCLUSIONS: Our experience supports that surgical reconstruction is not required, as we found ligation of the common iliac artery to be a safe and effective option.

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