Introduction We have developed a method that permits safer endovascular treatment via the femoral artery in neonates repeatedly in a short period of time, and have experienced a case of vein of Galen malformation in a neonate who made good progress without any particular complications after undergoing staged embolisation. Here, we report the procedure of this method.

Materials and Methods A female neonate who was born by Caesarean operation at 37 weeks of gestation and weighted 2790 g, presented with respiratory distress, cardiac failure and pulmonary artery hypertension soon after birth. Vein of Galen malformation (choroidal type) was diagnosed by head ultrasound and cranial computed tomography. Lansjaunias’s Neonatal evaluation score was 11. Thus, endovascular embolisation was emergently performed.

A 3Fr × 25cm Supersheath (Medikit Co Ltd, Tokyo, Japan) was placed in the discending aorta temporarily via a transfemoral approach, and then a 3.3Fr × 50 cm diagnostic catheter (Medikit Co Ltd, Tokyo, Japan) with a 0.025-inch guidewire was placed through the Supersheath and used for vessel selection. Selective arteriography was performed using the diagnostic catheter. The diagnostic catheter was passed into the common carotid or the subclavian artery over the guidewire and positioned in the internal carotid or the vertebral artery. The supersheath was then advanced into the aortic arch to cannulate the internal carotid or the vertebral artery over the diagnostic catheter. This time, we have achieved a less invasive embolisation with a transfemoral approach using the supersheath itself as a guiding catheter.

Results We performed transvenous embolisation (TVE) after multi-staged transarterial embolisation (TAE) with the femoral artery puncture (right: 3 times; left: 2 times) (as a diagnostic catheter during the transvenous embolisation) in a short period of approximately 80 days. Subsequently, the patient demonstrated good progress without any particular complications, and was able to be safely discharged from the hospital five months after the birth, remained neurologically stable at 2 year after treatment and did not develop any new symptom related to the malformation.

Conclusion With regard to neonates (low-birth-weight newborns), there is an increased risk of ischaemia in the lower limbs as a consequence of the insertion of a sheath on account of the thinness of their femoral artery. Particularly in the cases of arteriovenous fistulae such as a vein of Galen malformation, which require endovascular treatment, the blood flow to the descending aorta and femoral artery is often insufficient due to high-flow shunt. For this reason, the risk of lower limb ischaemia is presumed to be higher in low birth-weight newborns than in normal infants. Our method utilising a 3Fr supersheath appeared to be safe and effective without any fear of ischaemia in the lower limbs. We therefore conclude that the method would be useful not only for endovascular treatment in neonates, but also for angiography.

Disclosures T. Nagayama: None. H. Uchida: None. Y. Nishimuta: None. K. Arita: None.