Aortic aneurysm resulting from umbilical artery catheterization: Case report, literature review, and management algorithm

Abstract

Aortic aneurysms in infants and children are quite rare. The use of umbilical artery catheters in the management of critically ill neonates has been associated with infection and subsequent aneurysm formation. There have been 46 cases reported (including our own); most of the aneurysms have been located in the abdominal aorta and have displayed saccular morphology. Through an analysis of the literature, we identified two factors that had significant correlation with improved survival: diagnosis before surgery and surgical repair (P <.05). This report presents the case of a 23-day-old neonate with an abdominal aortic aneurysm and hypertension. On the basis of our literature review, we offer a management algorithm for this rare but very serious complication of umbilical artery catheterization.

Mycotic Saccular Abdominal Aortic Aneurysm in an Infant after Cardiac Catheterization: A Case Report

“…6,13 Mycotic AAA typically occurs before age 2 and commonly presents with features such as a palpable abdominal mass, poor feeding, persistent hypertension, sepsis, and/or catastrophic rupture. 2,14 Organisms commonly encountered on blood and tissue culture include Staphylococcus, Streptococcus, Salmonella, Pneumococcus, Klebsiella, Pseudomonas, Enterobacter, Enterococcus, and Candida, with Staph species implicated most often in association with mycotic AAA. 2,6,7 It should be noted, however, that in many cases of children with prior bacteremia and a diagnosis of mycotic aneurysm, Gram stain and culture of the excised segment has shown no growth, owing in all likelihood to prior administration of antibiotics.…”

Resolution of Multiple Aortic Aneurysms in a Neonate

“…3,4,13 The precise mechanisms leading to aneurysm formation remain unclear. Mechanical trauma from a UAC tip routinely produces aortic endothelial injury which leads to thrombus formation.…”

“…Aortic aneurysms may develop in the abdominal aorta (43%), thoracic aorta (30%), iliac artery (15%), and thoracoabdominal aorta (12%) with most aneurysms being of the saccular type. 3 Any neonate with UAC placement and S aureus sepsis should be considered at increased risk for aortic aneurysm development. These infants should have their UACs removed, appropriate antibiotics started, and be followed serially with ultrasound to monitor for the development of aortic aneurysms.…”

“…1 Aortic aneurysms, with reported high morbidity and mortality, have also been reported in association with UAC's. [2][3][4] We report a case of a 24-week infant who developed multiple aortic aneurysms associated with use of an UAC complicated by a Staphylococcus aureus infection with subsequent spontaneous resolution of aneurysms after 5 months.…”

Clinical outcome of umbilical artery catheter-related thrombosis—a cohort study

“…In our cohort, no sequelae were found until clot resolution, however, long-term complications like increased systolic and diastolic blood pressure, calf circumference discrepancy 36 and abdominal aortic aneurysm mostly related to Staphylococcus infection have been previously described. 37 The strength and uniqueness of this study is its design. All surviving infants who had UACRT were followed clinically and ultrasonographically until total clot resolution.…”