Endovascular Occlusion of an External Iliac Artery Rupture as an Alternative to Open Vascular Surgery.

A 5-month-old (5.7 kg) infant with trisomy 21 suffered an external iliac artery (EIA) rupture following femoral arterial access for attempted percutaneous retrograde ventricular septal defect (VSD) closure. An endovascular occlusion approach was employed as an alternative to high-risk open vascular surgery. The infant experienced a cardiac arrest during anaesthetic induction, with angiography revealing active EIA bleeding. The vessel was successfully occluded with an Amplatzer Piccolo device, with distal perfusion likely preserved with collateralisation via the internal iliac artery. Recovery was uneventful, with good perfusion of the right leg, though at 4-month follow-up, there is a mild limb-length discrepancy. To our knowledge, this is the first reported case of emergency endovascular EIA occlusion in an infant following cardiac catheterisation as an alternative to open surgery.