Umbilical Artery Access for PDA Stenting: Feasibility in Select Anatomy

Patent ductus arteriosus (PDA) stenting is a less invasive alternative to surgical shunts in ductal-dependent congenital heart disease. Umbilical artery access for PDA stenting offers femoral-like retrograde advantages while avoiding associated risks, however is underreported in this context. This study evaluates umbilical artery access feasibility and outcomes for PDA stenting. A case series included seven neonates undergoing PDA stenting via umbilical artery access between 01/17/2020 and 10/30/2024 at Rady Children's Hospital, San Diego. Patient demographics, PDA morphology, and procedural details were collected. Existing umbilical arterial lines were rewired and exchanged for a 4 F Flexor sheath (Cook Medical Bloomington, Indiana, USA), advanced through the iliac artery to the descending aorta. A coaxial system was used to cross the PDA and deploy coronary stents with a wire-locking technique for controlled positioning. Post-procedure, patients received dual antiplatelet therapy with the umbilical catheter remaining in situ until stability. This study (71% female) had a median gestational age of 38 weeks and a median birth weight of 2.97 kg. The median age at catheterization was 8 days (range: 3-10). PDA morphology originated from the descending aorta (n = 4, 57.1%) and the brachiocephalic artery (n = 3, 42.9%). The median procedure time was 126 min (range: 42-161 min), with a median fluoroscopy time of 24.7 min (11.4-58.6). No intra- or post-procedural complications occurred. Median stent diameter was 3.5 mm; 85.7% required one stent. Scheduled reinterventions, as part of staged palliation, were performed in a subset of patients. Umbilical artery access for PDA stenting is a safe and effective alternative in select cases, with no acute complications in our study.