Umbilical venous access through the ductus arteriosus for arterial embolization of a neonatal sacrococcygeal teratoma

BACKGROUND: Sacrococcygeal teratoma (SCT) is the most common germ cell tumor in children and the most frequent fetal neoplasm. The treatment of choice is complete surgical resection. Preoperative endovascular embolization has proven to be a safe and effective technique to reduce bleeding rates before and during surgery. In previously reported cases, the vascular access chosen for embolization was always arterial (carotid, subclavian, or femoral). However, in neonates, the small caliber of arteries, their greater propensity for spasm, and the risk of puncture-related complications sometimes make the vascular access the most challenging step of the procedure. CASE PRESENTATION: In this work, the authors present a case of successful preoperative embolization of an SCT in a newborn on the first day of life, using an innovative vascular approach to control perioperative bleeding by accessing the arterial circulation through the ductus arteriosus via umbilical venous access. This technique allowed safe and effective embolization while avoiding arterial puncture. CONCLUSIONS: While anatomical feasibility depends on ductus arteriosus patency, this approach may be valuable in selected neonates with SCTs where femoral access is technically challenging. Additional advantages include avoiding arterial puncture, thus reducing the risk of arterial spasm, thrombosis, or hemorrhage, and the fact that the umbilical vein is an already commonly used access in pediatrics, thereby reducing the risks inherent to neonatal arterial access and achieving comparable technical success.