Surgical Treatment of Abdominal Aortoiliac Aneurysms in Children: A Case Series and Systematic Literature Review

Purpose: Abdominal aortoiliac aneurysms (AAIAs) in pediatric patients are very rare, but rupture is often fatal. This study aimed to analyze causes, surgical management strategies, and clinical outcomes in pediatric patients with AAIAs who underwent surgical treatment. We also performed a systematic literature review of previously reported cases to inform diagnostic and therapeutic approaches. Materials and Methods: A retrospective case series analysis was conducted of consecutive pediatric patients (age <20 years) diagnosed with abdominal aortic or iliac artery aneurysms who underwent surgical treatment at Seoul National University Hospital from 1997 through 2025. A systematic literature review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase, and Web of Science were searched for publications from 1913 through 2025 using search terms including "child", "pediatric", "abdominal aortic aneurysm" and "iliac artery aneurysm". Results: Surgical treatment was successfully performed in five patients, with no perioperative mortality. During a median follow-up of 5 years, four patients were alive with stable outcomes and no aneurysm recurrence or ischemic complications. One patient with tuberous sclerosis complex died 5 years after surgery from seizure-related complications. One patient developed early graft thrombosis but remained asymptomatic due to good collateral circulation. The systematic literature review summarized 96 reported cases of pediatric AAIAs, showing diverse etiologies and surgical approaches and generally favorable long-term outcomes when appropriately managed. Conclusion: Although rare, pediatric AAIAs carry a significant risk of rupture and death, requiring prompt diagnosis and surgical treatment. Experience from pediatric vascular reconstruction suggests that appropriate graft selection and anticipation of somatic growth are key for durable outcomes. Preservation of collateral circulation is crucial, as children demonstrate remarkable tolerance to graft occlusion. Further multicenter studies are needed to establish standardized management protocols for this rare condition.