Transumbilical arterial embolization of a large dural arteriovenous fistula in a low-birth-weight neonate with congestive heart failure

Abstract

This patient apparently was the lowest birth weight neonate with a large AVF successfully treated by embolization, which is usually performed through the transfemoral arterial route. The transumbilical arterial route is an alternative for neonates with birth weight <2000 g and very small femoral arteries.

Coil and Onyx embolization of a torcular herophili dural arteriovenous fistula in a full-term neonate with advanced heart failure using a transumbilical approach

“…13 In 1997, Berenstein et al was the first to utilize the umbilical arteries for endovascular treatment of cerebral arteriovenous malformations. 2 Komiyama et al demonstrated the utility of cannulating the umbilical vessels in a neonate weighing 2801 g. 8 This access had been reported in low birth weight, preterm neonates in cerebrovascular malformations typically weighing less than 2800 g. 12,17 Our patient weighing 2800 g received umbilical artery cannulation on the first day of life without complication. Adding to the singular case report by Komiyama et al who treated the normal birth weight neonate, we believe this case revisits the need to consider the umbilical vessels as endovascular access points in all neonates, regardless of birth weight.…”

“…Varying birth weights have been described to delineate when femoral access may be difficult. 9,17 Femoral vessel catheterization can be difficult in neonates of preterm status and of especially low birth weight (< 1500 g), making alternative vascular access points preferable. 18 Additionally, transfemoral cannulation of the neonate is associated with stenosis, occlusion, and thrombosis of the iliofemoral vessels more than any other age group.…”

“…2,8 Given the successful treatment of our patient, as well as several others presented in additional studies, the transumbilical approach may be a safer option than transfemoral in neonates, regardless of birth weight. 9,17 Challenges of the umbilical artery approach include vessel tortuosity and the angle of entry requiring the utilization of flexible catheters and wires for the intervention. The risks and benefits of utilizing the transumbilical approach in neonatal endovascular therapy must be weighed against those involved when attempting to cannulate the femoral vessels.…”

“…Oshiro et al utilized the transumbilical approach for glue embolization treatment of a DAVF of the torcula with 4 years of follow up, and the result was a neurologically normal patient. 17 A major concern following glue embolization is the risk of glucosylate deploying into normal vasculature. Berenstein et al in 1997 and Kincaid et al demonstrated the possibility of glue emboli dislodging and circulating through the vasculature.…”

Neuro-Interventions for the Neonates with Brain Arteriovenous Fistulas: With Special Reference to Access Routes

“…It is recommended to catheterize both umbilical artery and vein soon after delivery whenever possible for possible transumbilical approach in the cases with brain AVFs. 14 – 16 ) Umbilical arterial approach has, however, an inherent risk of vessel perforation, thromboembolic complications including leg ischemia, infection, aortic aneurysm, air embolism, hemorrhage, bladder rupture, and intestine perforation. 17 , 18 ) Using this approach, a neonate with dural sinus malformation with birth weight of 1,538 g was successfully treated.…”