Long sheath use in femoral artery catheterizations in infants &lt;15 kg is associated with a higher thrombosis rate

Ding, Linda; Pockett, Charissa; Moore, John W.; El‐Said, Howaida

doi:10.1002/ccd.26690

Cited by 25 publications

(22 citation statements)

References 12 publications

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“…We also afford more consistency in procedure technique and patient management as a single‐center evaluation compared to their six site survey across multiple countries. Loose definitions of arterial thrombosis are also used in previous studies, with the majority of documented thromboses based on pulse loss or liberal definitions including many mechanisms of vascular compromise . By selecting US visualization of thrombosis as our primary definition of documented thrombosis, this affords less chance for false positive findings of thrombosis and less variability in reporting between patients in our population.…”

Section: Discussionmentioning

confidence: 99%

“…Postcatheterization femoral arterial thrombosis in infants can result in acute limb loss and long‐term consequences including leg‐length discrepancy and difficulty obtaining vascular access in future procedures . Younger age, lower weight, and larger catheters have been reported as factors associated with increased thrombotic risk . Using standard clinical detection methods, prior studies have demonstrated a range of femoral arterial thrombosis rates from 0.3 to 9.6% .…”

Section: Introductionmentioning

confidence: 99%

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Routine postprocedure ultrasound increases rate of detection of femoral arterial thrombosis in infants after cardiac catheterization

Kamyszek

Leraas

Nag

et al. 2018

Cathet Cardio Intervent

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Objectives To examine the effect of implementing postcatheterization ultrasound (US) on femoral arterial thrombosis detection rates and factors associated with thrombosis in infants. Background Although femoral arterial thrombosis is an uncommon complication of cardiac catheterization, it can cause limb threatening complications. Previous studies assessing the utility of postprocedure US to detect thrombosis in infants have utilized US as an adjunct to standard clinical detection methods, are small scale, or include small cohorts of infants within older populations. Methods We reviewed institutional records of patients 0–12 months undergoing catheterization from 2007 to 2016. Demographics and procedural data were compared between the thrombosis and non‐thrombosis group. Pre‐ and post‐US groups were compared for detected thrombosis rate. Using univariate and multivariable analyses, we identified factors associated with thrombosis. Results In total, 270 patients underwent 509 catheterizations, with 40 (7.9%) documented thromboses. The rate of thrombus detection in patients younger than 6 months increased from 8.3% to 23.4% (P = 0.006) after implementing routine US. On multivariable analysis, lower weight (P < 0.001), larger arterial sheath size (P < 0.001), and longer procedure duration (P = 0.003) were independently associated with higher odds of thrombosis. Conclusions Higher rates of femoral arterial thrombosis detection were observed since implementing an US screening program. Further studies are needed to evaluate age‐related changes in hemostasis in this population and how advanced screening methods and anticoagulation protocols may help improve short‐term and long‐term sequelae of femoral arterial thrombosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Routine postprocedure ultrasound increases rate of detection of femoral arterial thrombosis in infants after cardiac catheterization

Kamyszek

Leraas

Nag

et al. 2018

Cathet Cardio Intervent

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“…This difficulty is exacerbated by the tortuous nature of ductus arteriosus in these patients . In addition, long sheath use in femoral artery catheterizations in infants <15 kg are associated with higher thrombosis rates …”

Section: Introductionmentioning

confidence: 99%

Percutaneous axillary artery approach for ductal stenting in critical right ventricular outflow tract lesions in the neonatal period

Breatnach

Aggarwal

Al-Alawi

et al. 2019

Cathet Cardio Intervent

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Objectives We aimed to assess the experience using a percutaneous axillary artery approach for insertion of arterial ductal stents in patients with critical right ventricular outflow tract lesions at two tertiary pediatric cardiology centers. Background Patent ductus arteriosus stenting is an accepted palliative alternative to BT shunts for neonates with critical right heart lesions. Access to tortuous ductus' may be challenging via the femoral artery, whereas the carotid artery presents a low risk of stroke. Recently, the axillary artery has been utilized for access in these patients. Methods We performed a retrospective review of neonates who underwent stent placement or angioplasty using percutaneous axillary artery approach at two tertiary care centers from October 2016 to November 2018. Medical records were reviewed to ascertain demographic, clinical, and outcome data. Results Axillary artery access was performed in 20 patients (16 primary ductal stents and 4 re‐interventions) at a median (IQR) procedural weight of 3.4 (3–3.9) kg. Median (IQR) procedural time was 110 (75–150) min. The median (IQR) ICU stay and intubation times were 14 (0–94) hr and 5 (0–40) hr, respectively. There were three access‐related vascular complications which were managed conservatively with no long‐term effects. Two patients subsequently died due to non‐procedure related causes. Conclusions Ductal stenting via a percutaneous axillary artery approach is a viable option in neonates with critical right ventricular outflow tract lesions. This approach provides an additional access site for PDA stenting which may be utilized in patients with vertical duct morphology.

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“…The vertical and tortuous ductus has been a risk factor for procedural failure especially with a femoral approach due to the acute angle of the wire course. Long femoral sheaths have also been found to be a major risk factor for femoral artery occlusion in this population . This then led some centers to explore carotid access for these procedures as the ductus arteriosus would be more in line.…”

Section: Discussionmentioning

confidence: 99%

Stenting the vertical neonatal ductus arteriosus via the percutaneous axillary approach

Lee

Ratnayaka

Moore

et al. 2019

Congenital Heart Disease

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Background/Objective Stenting the ductus arteriosus (DAS) has become an alternative to surgical systemic to pulmonary artery shunts in neonates with ductal‐dependent pulmonary blood flow (PBF). Femoral approach for a vertical ductus can be difficult secondary to the acute angle and tortuous course, thus alternative access sites have been explored. Carotid access complications have been reported in 5%‐10%. The extensive use of an axillary arterial approach in the United States has not been reported. The aim of this study is to describe our experience with DAS using the axillary approach. Methods We reviewed all patients with DAS with an axillary approach in neonates with ductal‐dependent PBF (May 2017‐May 2018) in our institution. Procedural reports, angiograms, and clinical records of all consecutive patients were reviewed. Procedural technique, procedural outcomes, adverse events, and post‐hospital courses are reported. Results Seven consecutive patients who received DAS utilizing axillary approach. All patients had ductal‐dependent PBF through a vertical, tortuous ductus. Five had pulmonary atresia or near atresia, one had compromised PBF due to dynamic subvalvar obstruction, and one had Tetralogy of Fallot with isolated left pulmonary artery. Axillary access with 3.3 or 4 French sheath was obtained using ultrasound guidance. Bare metal coronary stents were deployed successfully in all. Intra‐procedure, one developed in stent thrombus requiring re‐stenting. There were no procedural mortalities or major adverse events from axillary access. There is a steep learning curve. Hemostasis was achieved with manual compression. Two patients had reintervention at 6‐8 weeks. All patients underwent successful planned surgeries. Conclusions This series suggests DAS in neonates utilizing an axillary approach is a feasible and effective alternative for establishing PBF. Axillary arterial approach may be preferred as there is no risk to neurological sequelae and very low risk of limb complications. Larger series are needed to validate this approach.

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Long sheath use in femoral artery catheterizations in infants <15 kg is associated with a higher thrombosis rate

Abstract: The use of a long sheath in infants <15 kg is a significant risk factor for arterial compromise compared to short sheaths. Lower patient weight is also a contributing factor to increased incidence of complication, particularly in those <5 kg. © 2016 Wiley Periodicals, Inc.

Cited by 25 publications

References 12 publications

Routine postprocedure ultrasound increases rate of detection of femoral arterial thrombosis in infants after cardiac catheterization

Routine postprocedure ultrasound increases rate of detection of femoral arterial thrombosis in infants after cardiac catheterization

Percutaneous axillary artery approach for ductal stenting in critical right ventricular outflow tract lesions in the neonatal period

Stenting the vertical neonatal ductus arteriosus via the percutaneous axillary approach

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