Management of aortic XXXX secondary to umbilical artery catheters in neonates.

@entity1 @entity712 @entity101 @entity63 @entity2792 @entity810 @entity715
During the past ten years, we have surgically managed seven neonates who developed total occlusion of the distal aorta due to umbilical artery catheters. All @entity1 experienced symptoms of @entity712 . Five @entity1 presented with severe @entity101 , and all of these had aortorenal involvement: three @entity1 had aortorenal @entity715 and two @entity1 had @entity715 with suprarenal extension of @entity715 . Two @entity1 had aortoiliac @entity715 with clot confined to the infrarenal aorta. @entity715 imposes an additional severe hemodynamic insult in these already seriously ill @entity1 . Survival in this group of @entity1 depends upon prompt recognition of this problem, effective surgical correction, and careful perioperative management. Our experience suggests that this diagnosis should be entertained in the @entity1 presenting suddenly with @entity712 , @entity101 , or lower limb @entity63 after umbilical artery catheterization. The diagnosis is preferably confirmed by real-time ultrasound and/or radionuclide flow scan, although aortography may sometimes be necessary. Surgical management includes early transabdominal aortotomy with thrombectomy. Prompt thrombectomy resulted in the survival of six @entity1 . One @entity1 died in @entity810 . Renal function and leg perfusion is satisfactory in the remaining @entity1 , although one @entity1 required later operative correction of @entity2792 . Two additional @entity1 needed prolonged postoperative antihypertensive therapy for 14 to 34 months before this problem resolved. Long-term follow-up is necessary for managing @entity2792 and monitoring lower extremity perfusion.
