2019 Research Forum

Applicant: Alexander Wan RA Principal Investigator & Faculty Sponsor: Daniel Quesada MD

Retained Catheter in the Aorta

Daniel Quesada MD, James Rosbrugh MD, Alex Huang MD R2, Phillip Aguiniga-Navarrete RA, Alexander Wan RA

INTRODUCTION Here we report, to our knowledge, the first reported case of a pediatric umbilical catheter in the aorta on a patient who has carried the fractured catheter into adulthood.

CASE PRESENTATION A 25-year-old female with no past medical or surgical history presented to the emergency department com-plaining of intermittent epigastric and abdominal pulsatile sensation that she has experienced for the past year. An abdominal aorta ultrasound showed no evidence of aneurysm or dissection; however, a 3.9-centimeter echogenic tubular structure was found in the distal abdominal aorta, consistent with a catheter fragment. The patient reported that she was born 2-months premature at an outside hospital. Given her history and the ultrasound findings, there was high suspicion for a retained fragment of an umbilical catheter in the patient’s aorta. Vascular surgery was consulted and patient was seen in clinic but later lost to follow up prior to further imaging and treatment. DISCUSSION This case demonstrates an incidental finding of a retained umbilical artery catheter fragment in an adult pa-tient’s aorta. There are several case reports of retained umbilical artery catheter fragments in neonates and infants which resulted in thrombosis, infection, and embolization.1,2 Furthermore, given the recent increase in endovascular procedures, retained foreign bodies such as stents, coils, guidewire, and catheters in vascu-lature have become a common and serious complication.3 The recommended treatment for acute and nonadherent foreign body is endovascular retrieval which has a high success rate with minimal mortality. However, in the case of stable intravascular foreign bodies which are adherent to the vessel wall, the benefits of removal such as decreasing the risk of thrombosis and fur-ther migration should be weighed with the risks, and leaving the foreign body in place is an option.4 CONCLUSION The recommended treatment for acute and non-adherent foreign body is endovascular retrieval which has a high success rate with minimal mortality. However, in the case of stable intravascular foreign bodies which are adherent to the vessel wall, the benefits of removal such as decreasing the risk of thrombosis and fur-ther migration should be weighed with the risks, and leaving the foreign body in place is an option.

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