Disorders of the Abdominal Aorta and Major Branches
Diseases of the subdiaphragmatic aorta in the pediatric population constitute a rare and highly heterogeneous group of disorders that present a tremendous challenge and require a multidisciplinary treatment approach. When viewed from the broad perspective of vascular surgical diagnosis and treatments, these conditions can be separated into two distinct entities: aneurysmal disease and stenotic/occlusive disease. Effective vascular reconstruction in these patients must take into account highly specialized issues related to the small size of the vessels being reconstructed, the limited availability of effective conduit for reconstruction, the optimal timing for operative repair, the anticipated life-long length of follow-up, and the principles of surgical technique that need to be incorporated to accommodate for anticipated growth. Equally important, the biology of the underlying specific diagnosis and the need for optimal medical therapy, family counseling, and social services must be understood, instituted, and carefully monitored by a team that, in our experience, has required the expertise of not only the pediatric and vascular surgeons, but also geneticists, nephrologists, rheumatologists, cardiologists, pediatric intensive care specialists, interventional radiologists, neurologists, gastroenterologists, neurosurgeons, plastics/microvascular surgeons, and transplantation surgeons.