Interventional Thrombectomy for Neonatal Spontaneous Aortic Thrombosis: A Case Series and Review of Off-Label Device Use

Background: Neonatal aortic thrombosis, although rare, is a critical condition that can lead to severe morbidity and mortality. Spontaneous thrombosis is extremely uncommon, complicating diagnosis due to similarities with aortic coarctation. Standard treatments include heparinization and thrombolysis, but in severe cases, interventional or surgical thrombectomy may be required. This case series explores the role of interventional therapy in neonates with spontaneous aortic thrombosis, focusing on those with reduced systolic function or organ failure, and evaluates the effectiveness of off-label thrombectomy devices.

Methods: Three neonates with spontaneous abdominal aortic thrombosis were treated at Hannover Medical School between 2017 and 2023. Their cases were reviewed retrospectively, focusing on clinical presentation, diagnostic methods, therapeutic interventions, and outcomes. Treatment options included systemic thrombolysis and interventional thrombectomy using off-label devices. A comprehensive literature research was conducted reviewing the role of interventional thrombectomy in this patient group.

Results: The first neonate presented with severe multiorgan failure and underwent interventional thrombectomy but died due to postprocedural complications. The second case, less severe, was treated successfully with systemic thrombolysis, leading to full recovery. The third neonate, critically ill with multiorgan failure, underwent successful interventional thrombectomy and thrombolysis, resulting in restored aortic perfusion and recovery. The off-label use of the Amplatzer Vascular Plug II was more effective than the Amplatzer Piccolo PDA occluder in managing an organized thrombus. A literature review highlighted recent reports suggesting interventional thrombectomy as a promising first-line treatment for neonates with cardiac decompensation or imminent organ failure.

Conclusion: Interventional thrombectomy is a viable option for neonates with spontaneous aortic thrombosis in life-threatening situations involving decreased systolic function or organ failure. Early diagnosis and timely transfer to specialized centers are critical for optimal outcomes. Further research is needed to assess the safety and long-term efficacy of catheter-based interventions in these cases.

Publication History

Article published online:
11 February 2025