Systematic review of pediatric abdominal aortic aneurysms

Pediatric abdominal aortic aneurysms (AAAs) are rare and differ fundamentally from adult degenerative disease in terms of etiology, presentation, and management. We performed a systematic review to characterize the causes, clinical features, treatment strategies, and outcomes of pediatric AAAs.

This Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review was conducted using PubMed/MEDLINE, Embase, and Web of Science from inception through March 2025. Studies reporting AAAs in patients aged ≤18 years were included. Case reports and case series were eligible. The data extracted included demographics, aneurysm characteristics, etiology, presentation, management approach, complications, and outcomes.

A total of 77 studies encompassing 87 pediatric patients met the inclusion criteria. The median age at presentation was 13 months [interquartile range (IQR): 1-96 months], with some cases identified during the prenatal period. Etiologies were idiopathic congenital (50.6%), mycotic (26.4%), genetic disorders (17.2%), and vasculitis (5.7%). Nearly half of aneurysms were detected incidentally, including eight cases identified prenatally. Thirteen patients (15%) presented with rupture. Most aneurysms were infrarenal (81.6%), with a mean diameter of 4.6 cm. Open surgical repair was the predominant treatment (n = 74), most commonly using prosthetic grafts. The overall mortality rate was 17.2%, with deaths primarily associated with rupture or postoperative complications. Survival was favorable in patients without rupture undergoing repair.

Pediatric AAAs represent a heterogeneous and clinically significant entity distinct from adult disease. Early recognition in high-risk populations and timely surgical intervention are critical. Given the absence of pediatric-specific guidelines, multicenter collaboration and long-term surveillance data are needed to inform evidence-based management strategies.