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Updated: Jul 4, 2026
Modified Octopus Technique for Thoracoabdominal Aortic Aneurysm
Published on: August 1, 2025
Complex vascular reconstruction of abdominal aorta and its branches in the pediatric population
Adam J Kaye1, Alison E Slemp, Benjamin Chang
1Department of General Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
Insights
Pediatric subdiaphragmatic aortic diseases are rare but require multidisciplinary care. Prompt surgery for aneurysms and medical management for stenoses until autologous grafts are feasible offer good outcomes.
Area of Science:
- Vascular Surgery
- Pediatric Cardiology
- Pediatric Nephrology
Background:
- Subdiaphragmatic aortic diseases in children are uncommon and present unique management challenges.
- Pediatric patients require consideration of size, growth, and optimal repair timing.
Purpose of the Study:
- To review operations involving the abdominal aorta and its branches in pediatric patients.
- To analyze preoperative evaluation, operative techniques, and outcomes for subdiaphragmatic aortic diseases in children.
Main Methods:
- Retrospective review of 22 pediatric patients (2 days to 17 years) undergoing abdominal aortic operations (2003-2007).
- Analysis of surgical repair details, graft types (allograft, Dacron, saphenous vein), and multidisciplinary team involvement.
Main Results:
- Five aneurysms (often incidental) and stenotic disease (presenting with hypertension) were identified.
- Fourteen complex vascular repairs were performed; aneurysms were treated promptly, while stenoses were managed medically until autologous grafts were viable.
- No major operative complications occurred, with a mean follow-up of 28 months.
Conclusions:
- Multidisciplinary management is crucial for pediatric aortic vascular disease.
- Autologous grafts are preferred; medical management of hypertension is advised for stenotic disease until reconstruction is feasible.
- Aneurysmal disease necessitates prompt intervention due to embolism and thrombosis risks, potentially using artificial grafts.
Background:
Subdiaphragmatic aortic diseases in children are rare and form a heterogeneous group. The pediatric patient presents unique challenges because of their size, concerns about proper timing and conduit for repair, and anticipating expected growth.
Methods:
We performed a retrospective review of operations involving the abdominal aorta and called branches in children between January 2003 and April 2007, focusing on the details of preoperative evaluation, operative technique, and outcomes. The pertinent literature is reviewed.
Results:
Twenty-two children (age, 2 days to 17 years) were included. Mean follow-up was 28 months. Aneurysms were seen in 5 children; the remainder had stenotic disease. Aneurysms were typically asymptomatic and diagnosed incidentally, whereas stenotic lesions most commonly presented with hypertension (HTN). Fourteen complex vascular repairs were performed. All of the children with aneurysms underwent prompt surgery. The children with stenoses had operations for poorly controlled HTN, claudication, and/or mesenteric ischemia. Most patients with stenotic disease were treated medically for HTN and were followed closely while awaiting optimal size and availability of autogenous conduit for reconstruction. Cryopreserved allograft was used in 3 of the aneurysm operations. Dacron grafts were used to repair 5 aortic stenotic lesions. Renal and mesenteric revascularizations were performed with saphenous vein grafts. Pediatric, general, and transplant surgeons and nephrologic and cardiologic teams were integral to evaluation and management. No major operative complications occurred.
Conclusion:
Proper management of pediatric aortic vascular disease requires a multidisciplinary approach. It is best to use autologous grafts whenever possible. Children with stenotic disease should be treated medically for hypertension until they are large enough for an autologous graft reconstruction. Children with aneurysmal disease are at risk for embolism and thrombosis and therefore usually treated immediately using artificial graft material, if necessary.
