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Case series
Standard umbilical artery catheters used as diagnostic and neurointerventional guide catheters in the treatment of neonatal cerebrovascular malformations
  1. Ari D Kappel1,2,3,
  2. Darren B Orbach3,4
  1. 1Neurosurgery, Boston Children's Hospital, Boston, Massachusetts, USA
  2. 2Neurosurgery, Harvard Medical School, Boston, Massachusetts, USA
  3. 3Neurointerventional Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
  4. 4Radiology, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Darren B Orbach, Neurointerventional Radiology, Boston Children's Hospital, Boston, Massachusetts, USA; darren.orbach{at}childrens.harvard.edu

Abstract

Background Vascular access in neonates is limited by the small size of the femoral artery and the risk of complications, including thrombosis and limb ischemia. Although umbilical artery access has been described, previous reports detail exchange of the umbilical artery catheter (UAC) for a conventional arterial sheath, which can be difficult and cumbersome. We aim to describe direct use of the UAC as the sheath and guide catheter in neonatal patients requiring endovascular treatment for life-threatening intracranial arteriovenous shunts.

Methods We reviewed all cases between 2016 and 2021 of neonatal intervention using a direct UAC approach. We describe our technique of utilizing UACs for cerebral angiography and neurointerventions in newborns without catheter exchange, allowing for repeated, straightforward endovascular access in neonates across multiple interventions.

Results Seven consecutive neonates underwent endovascular neurointerventional procedures for the treatment of life-threatening, high-flow arteriovenous shunts using a direct UAC access technique without procedural morbidity. Five of seven patients underwent more than one procedure in the neonatal period, between day 1 and day 10 of life.

Conclusions Use of the UAC itself as a diagnostic catheter for cerebral angiography or as a guide catheter for neurointerventions greatly facilitates endovascular interventions in newborns and is ideal for patients requiring multiple interventions in the neonatal period. This technique helps to mitigate the risk of neonatal femoral artery access and its complications, including thrombosis, dissection, spasm, stenosis, and limb ischemia.

  • Catheter
  • Congenital
  • Pediatrics
  • Vascular Malformation
  • Vein

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Footnotes

  • Contributors DBO was responsible for the conception and design of the work. ADK and DBO contributed to the data collection, analysis, and interpretation, as well as drafting, critical revision, and final approval of the article to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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