Femoral Arterial Thrombosis After Cardiac Catheterization In Infancy: Impact of Doppler Ultrasound for Diagnosis

Abstract

Femoral arterial thrombosis (FAT) is a nonnegligible complication after cardiac catheterization (CC) in infancy. The aim of this study was to evaluate the impact of Doppler ultrasound (US) for diagnostic work-up after catheterization. We compared standard follow-up (FU) without Doppler US by relying on clinical signs of FAT with advanced FU using Doppler US of the femoral vessels. Between January and December 2009, we evaluated the rate of FAT in infants <12 months of age using a multicenter, prospective observational survey. We analysed 171 patients [mean age 4.1 ± 3.3 (SD) months; mean body weight 5.3 ± 1.8 kg] from 6 participating centres. The mean duration of catheter studies was 57.7 ± 38.0 min. The overall rate of FAT based on clinical diagnosis was 4.7% and was comparable in both groups [3.4% undergoing standard FU vs. 7.4% undergoing advanced FU (p = 0.15)]. However, the overall rate of thrombosis as screened by Doppler US was greater at 7.1 %, especially in patients after advanced FU [18.5% advanced vs. standard FU 1.7% (p < 0.01)]. In conclusion, FAT remains a relevant and underestimated complication after catheterization in young infants when relying only on clinical signs of FAT. Therefore, to start effective treatment as soon as possible, we recommend Doppler US to be performed the day after CC.

Incidence and predictors of cardiac catheterisation-related arterial thrombosis in children

“…In line with previously reported data, our study clearly shows that arterial thrombosis after CC predominantly affects neonates and infants aged <12 months 4–6 9 11 21 25 26 31. An overall analysis of patients with a large range of age may therefore underestimate the incidence of thrombosis 4 8 10 12 15 18 20 21 23 26 33…”

“…The fact that only 57 of the 171 patients had undergone routine Doppler ultrasound suggests major bias in the recruitment of patients. Although ultrasound was not performed routinely in our patients, using clearly defined clinical diagnostic criteria, the incidence of arterial thrombosis in our study was similar to the incidence reported by Kocis et al and significantly increased compared with the ones reported by Hanslik et al 12 and Knirsch et al 13. As long as no validation data are available on the use of Doppler ultrasound as compared with angiography, which is still considered the gold standard for the diagnosis of arterial thrombosis, our data indicate that a well-defined and intensive clinical monitoring of children after CC can be considered a valuable diagnostic tool.…”

“…Several studies were focused on arterial thrombosis and on overall complications of CC 4 5 9 16 29 30. Other studies were designed to evaluate diagnostic tools to detect thrombosis or the effect of prophylactic administration of heparin to prevent arterial thrombosis or to evaluate the effect of different thrombolytic agents to dissolve arterial thrombosis after CC 8 10 12 13 18 19 21–23 25–28 32–34…”

“…Several studies have recommended the use of ultrasound screening after CC to detect arterial thrombosis 10 12 13. In the study by Hanslik et al ,13 all included patients were screened with ultrasound after CC and the reported incidence was low (3%).…”

“…Of the seven infants with arterial thrombosis on ultrasound, only four had clinical signs of femoral artery compromise, which are not specified in the manuscript. A more recent, multicentre study has evaluated both clinical diagnosis and routine Doppler ultrasound for the diagnosis of CC-related arterial thrombosis in two groups of infants 12. In the first group, diagnosis of arterial thrombosis was made first clinically and subsequently confirmed by Doppler ultrasound.…”