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Published on: May 21, 2017
Case Report: Trans-axillary Artery Access for Rescue Stent Implantation in an Infant With Retrograde Non-passable
Julia Moosmann1, Ariawan Purbojo2, Susanne Eder1
1Department of Pediatric Cardiology, Friedrich-Alexander University of Erlangen-Nürnberg (FAU), Erlangen, Germany.
Insights
This study shows balloon angioplasty and stenting can be a viable bridge to surgery for infants with critical coarctation of the aorta. An alternative right axillary artery approach is effective when traditional methods fail.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Critical duct-dependent coarctation of the aorta (CoA) traditionally requires primary surgical repair.
- Infants with comorbidities like pneumonia may be inoperable for initial surgery.
- Balloon angioplasty (BA) is an established rescue strategy for severe CoA.
Observation:
- A case of an initially inoperable infant with severe CoA, pneumonia, and respiratory failure is presented.
- Traditional retrograde femoral access failed to cross the aortic stenosis.
- An alternative antegrade right-axillary artery approach was successfully used for BA and stent implantation.
Findings:
- Stent implantation in critically ill infants serves as a successful bridge to subsequent surgical repair.
- The right axillary artery approach is a feasible alternative for interventional procedures when retrograde access is not possible.
- This intervention did not preclude successful definitive surgical repair.
Implications:
- Highlights the utility of palliative balloon angioplasty and stenting for inoperable infants with critical coarctation of the aorta.
- Establishes the right axillary artery approach as a valuable alternative access route in complex pediatric interventions.
- Demonstrates that interventional procedures can facilitate future surgical outcomes in high-risk neonates and infants.
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.
