External iliac artery thrombosis: an unusual complication of femoral venous catheterisation in a neonate

Abstract

We report a neonate who developed external iliac artery thrombosis after insertion of femoral venous catheter, without an apparent arterial puncture during the procedure. The baby developed acute limb ischaemia. As there was no improvement despite heparin infusion for 24 hours, thrombectomy was done. Following surgery, the limb perfusion improved gradually in 1 week. However, pulses did not reappear even after antithrombotic therapy for 3 months. There was residual Doppler abnormality in the form of severe narrowing at the origin of superficial femoral artery with reduced flow velocity in superficial femoral, popliteal and tibial arteries. The baby was kept under regular follow-up, with a plan for clinical assessment and Doppler every 6 months and to perform a vascular reconstructive surgery if he develops any clinical feature of chronic limb ischaemia. The baby is now 1 year of age. He is walking normally and there is no limb length discrepancy.

Keywords: neonatal intensive care; vascular surgery.

Figure 1

Doppler ultrasound of right lower limb showing (A) normal blood flow in CIA, (B) echogenic focus within the lumen in EIA suggestive of thrombus and (C, D) compressible SFA and ATA with monophasic flow. EIA, external iliac artery; R ATA, right anterior tibial artery; R CIA, right common iliac artery; R SFA, right superficial femoral artery; T; thrombus.

Figure 2

Doppler ultrasound of the right lower limb after 3 months showing (A, B) severe narrowing at the origin of SFA with turbulent flow, (C) R SFA D showing low-velocity flow (peak systolic velocity of 16.8 cm/s) and (D) L SFA D showing normal velocity (peak systolic velocity of 70.0 cm/s) flow (for comparison). L SFA D, left distal superficial femoral artery; R CFA, right common femoral artery; R SFA D, right distal superficial femoral artery;