Endovascular Management of Upper Limb Arterial Aneurysms in a Child With Kawasaki Disease

Abstract

Background

Kawasaki disease is an acute, self limited vasculitis that predominantly affects children under five years of age. It is clinically diagnosed by persistent fever for at least five days along with four of the main clinical features. Bilateral upper limb aneurysms are rare in Kawasaki disease, with limited literature comprising case reports and small series, leaving management guidelines unclear.

Report

This study presents the case of a three year old male with a history of incomplete Kawasaki disease at eight months of age. Initial treatment included two doses of gammaglobulin after which he was diagnosed with aneurysms in both the left and right coronary arteries; he remained in a stable condition under bi-annual monitoring. Six months later, the patient was referred having developed aneurysms in the left axillary and right brachial arteries. Open and endovascular approaches were discussed with his parents; endovascular management was opted for. Covered stents (6 x 56 mm and 8 x 56 mm Fluency Plus Endovascular Stent Graft, Becton Dickinson & Co., New Jersey, USA) were successfully placed in the left axillary and right brachial arteries during a single procedure. The patient remained haemodynamically stable and was discharged 24 hours post-operation without complications. At the 24 month follow up, the patient was asymptomatic, and ultrasound confirmed the continued patency of the stents.

Conclusion

This case highlights the importance of individualised treatment strategies for paediatric patients with Kawasaki disease complicated by arterial aneurysms. The use of stent grafts in children presents unique challenges, including long-term durability, vessel growth, and thrombosis risk, necessitating careful patient selection and lifelong follow up. The successful outcome observed in this case highlights the potential of endovascular techniques as a viable alternative to open surgery, emphasising the need for further studies to establish standardised guidelines for paediatric vascular interventions.