Transvenous balloon angioplasty for relief of complete thrombotic occlusion of the descending aorta

Case report. We report on a neonate born after 40 weeks of gestation who wa s transferred to our institution with suspected co-arctation of the aorta. Echocardiography disclosed a thrombotic occlusion of the descending aorta d istally to the renal arteries. Angiography and transcatheter balloon angiop lasty were performed using an anterograde venous approach with passage of t he catheter through the foramen ovale into the arterial system via a loop i n the left ventricle. Blood flow across the descending aorta was effectivel y restored. The left iliac artery, however, could not be recanalized interv entionally due to long-standing thombotic occlusion. Since there was extens ive collateral formation perfusion of the left lower extremity was not comp romised. Follow-up with Duplex-sonography demonstrated complete patency of the descending aorta 12 months postinterventionally. Discussion. In pediatric patients, transcatheter recanalization and balloon angioplasty of arterial thrombosis can be performed using a venous approac h and should be considered as an alternative to fibrinolytic therapy.