Management of arterial pseudoaneurysms of the neck in pediatric population: An endovascular case series and review of literature.

BACKGROUND: Arterial pseudoaneurysms of the neck are rarely reported in pediatric population with no dedicated large series available yet. Trauma and infection are the most common causes for these aneurysms, with congenital and collagen vascular disorders being the less common etiologies. These lesions can be life threatening, especially when they present with bleeding or airway compromise.

METHODS: We searched our radiology information system for all cases of pediatric neck aneurysm presented between June 2015 and May 2018. They were analyzed for clinico-epidemiological variables, clinical presentation, imaging findings, management and follow-up.

RESULTS: Six children were included in the study (M:F - 5:1), with mean age of 7.8 years (2.5-15). Four of them presented acutely with either bleeding or rapidly enlarging neck swelling, while two presented with slowly increasing pulsatile swelling. One had a traumatic etiology, two had infections, and one had infective cervical lymphadenitis complicated by iatrogenic injury while no definite causative mechanisms could be accounted for in two cases. Two of the kids were managed by trapping of the aneurysm and two only by proximal parent vessel occlusion. The other two children were treated with stent graft deployment across the aneurysm neck to reconstruct the parent vessel. All the patients are doing well during the follow up period (mean - 14.8 months).

CONCLUSION: Endovascular means of treatment for the pediatric neck aneurysms is relatively simple and safe. Although parent vessel sacrifice is the gold standard management, vessel preserving strategies can be tried in select cases with favorable anatomy.