Case Report: Trans-axillary Artery Access for Rescue Stent Implantation in an Infant With Retrograde Non-passable Aortic Coarctation

Abstract

Primary surgical repair remains the traditional treatment for patients with critical duct-dependent coarctation of the aorta (CoA). Initial surgical repair might not be possible or associated with higher risks if additional comorbidities arise in small infants and neonates. Balloon angioplasty (BA) has been described as a rescue strategy for these children. We describe the feasibility of a palliative BA and rescue stent implantation via an alternative antegrade right-axillary artery approach in an initially inoperable infant with pneumonia and respiratory failure and severe CoA, where the stenosis was not passable by traditional retrograde femoral access. This case adds new aspects to the therapy of critical CoA: Stent implantation provides a bridge to surgery in critically ill infants and does not preclude successful surgical repair. Further, if the classic retrograde approach is not possible, the right axillary artery access should be considered as an alternative to pass the stenosis.

Systematic approach to obtain axillary arterial access for pediatric heart catheterizations

“…The arm continues to be perfused by the second intercostal and acromial arteries while the axillary artery is cannulated. Two categories of patients with CHDs that are better treated from the AAA are neonates with critical aortic valve stenosis with or without aortic coarctation as well as those with duct-dependent pulmonary circulation and a tortuous arterial duct originating from the inner curve of the aortic arch opposite to the origin of the left or the right subclavian artery (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). The axillary artery is felt better than the femoral artery in low birth weight newborns, particularly in those suffering from critical aortic coarctation with non-palpable femoral pulses.…”

“…favorable for procedures like balloon dilation of critical aortic valve stenosis, stenting vertical arterial ducts, opening the struts of previous ductal stents, treating critical aortic coarctation in low birth weight patients, and Blalock-Taussig shunt (BTS) shuntrelated interventions (4)(5)(6)(7)(8)(9)(10)(11)(12)(13). This is in addition to other cases where femoral arterial access is difficult for many reasons related to low birth weight, vascular abnormalities, or low cardiac output (1-3).…”

Successful treatment of re-coarctation of the aorta with percutaneous stent placement via axillary artery access in a young patient

“…3 In the current literature, percutaneous stent placement via the axillary artery was performed in limited cases of coarctation of the aorta, particularly in those with re-coarctation of the aorta. [4][5][6] Thus, we hereby present the first case of a patient who had a successful percutaneous stent placement via trans-axillary access in our center.…”