Successful treatment of re-coarctation of the aorta with percutaneous stent placement via axillary artery access in a young patient

Çınar, Ayşegül Aslan; Yücel, İlker Kemal; Çelebi, Ahmet

doi:10.1017/s1047951122001639

Cited by 1 publication

(1 citation statement)

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“…The axillary artery is felt better than the femoral artery in low birth weight newborns, particularly in those suffering from critical aortic coarctation with non-palpable femoral pulses. In these patients, the use of femoral arterial access has a high risk of significant vessel damage due to low cardiac output and impaired flow to the lower part of the body ( 4 – 10 ). The carotid artery approach, whether surgical or percutaneous, is another alternative with many reported technical benefits and promising outcomes ( 17 – 19 ).…”

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confidence: 99%

Systematic approach to obtain axillary arterial access for pediatric heart catheterizations

Haddad,

Karmustaji,

Alloush

et al. 2024

Front. Cardiovasc. Med.

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BackgroundAxillary arterial access (AAA) in pediatric heart catheterizations is undervalued.MethodsWe retrospectively reviewed children with congenital heart diseases (CHDs) who received trans-axillary arterial catheterizations between January 2019 and February 2023. We aimed ultrasound-guided punctures in the proximal two-thirds of axillary arteries with diameters ≥2 mm to insert 7 cm/4 Fr short introducers. We administrated intra-arterial verapamil (1.25 mg) and heparin (100 UI/kg). We infiltrated per-operatively 2% lignocaine (10 mg) for arterial spasms, long sheaths use (≥5 Fr), and ≥60 min procedures in <3 kg patients.ResultsWe identified 30 patients (66.7% males) with a median age of 1.1 months (IQR, 0.3–5.4), and a median weight of 3.1 kg (IQR, 2.7–3.7). 5/30 patients had six redo interventions after a median of 3.9 months (IQR, 1.7–5.1). Overall, 27/36 procedures were interventional, including 6 aortic valvuloplasties, 6 balloon angioplasties, and 15 stenting procedures. The median arterial axillary angiographic diameter was 2.6 mm (IQR, 2.4–3). Access was right-sided in 23/36 (63.9%) procedures and obtained using 21G/2.5 cm bevel needles in 25/36 (69.4%) procedures. No hemodynamical change occurred after introducing spasmolytic drugs. The median fluoroscopy time was 26.1 min (IQR, 19.2–34.8). There were two self-resolving arterial dissections, one sub-occlusive arterial thrombosis (resolved with 6 weeks of enoxaparin), and one occlusive arterial thrombosis (resolved with alteplase thrombolysis and 6 weeks of enoxaparin). Median follow-up was 11.7 months (IQR, 8–17.5). Four patients with complex univentricular hearts died from non-procedural causes at a median of 40 days (IQR, 31–161) postoperative.ConclusionSystematic approach for AAA is the key to success and unlocks the many potentials of trans-axillary pediatric cardiology interventions.

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