Noninvasive evaluation of neonatal aortic thrombosis secondary to umbilical artery catheterization.

Abstract

Neonatal aortic thrombosis, once a rare entity, is now seen with increasing frequency as a complication of umbilical artery catheterization (UAC). Two studies used contrast aortography to demonstrate that the incidence of thrombosis in asymptomatic infants with indwelling UACs is greater than 90% [1 , 2]. Although these studies show that varying amounts of thrombus formation are usually present after catheterization, most of these thnomboses apparently resolve spontaneously without clinical sequelae. Occasionally, the aortic thrombosis progresses to occlusion, with a very high nonoperative mortality rate [3]. Recent advances in vascular surgery have made thrombectomy feasible in affected infants, and most can now be successfully managed by prompt emergency aortotomy [3, 4]. Sensitive, specific, and minimally invasive diagnostic methods are needed to help identify those neonates who require surgical intervention. This case report illustrates the relative roles of neal-time sonography, duplex pulsed Doppler sonognaphy, and radioisotope angiography in evaluating this problem.