Catheterization and Cardiovascular Interventions 00:00Š00 (2016)
DOI: 10.1002/ccd.26702
Received 8 December 2015; Revision accepted 11 July 2016
© 2016 Wiley Periodicals, Inc.
Ultrasound-Guided
Femoral Arterial Access in Pediatric Cardiac Catheterizations: A Prospective
Evaluation of the Prevalence, Risk Factors, and Mechanism for Acute Loss of
Arterial Pulse
Author
John Alexander, DO1, Thomas Yohannan, MD1, Iman Abutineh,
BS1, Vijaykumar Agrawal, MD2,
Hannah Lloyd, RN1, David Zurakowski, PhD3,
B. Rush Waller III, MD1, Shyam Sathanandam, MD1*
1Department of Pediatrics,
Division of Pediatric Cardiology, University of Tennessee Health Science
Center, Le Bonheur ChildrenÕs Hospital, Memphis, Tennessee 2Department
of Radiology, University of Tennessee Health Science Center, Le Bonheur
ChildrenÕs Hospital, Memphis, Tennessee 3Department of
Biostatistics, Harvard Medical School, Boston, Massachusetts
Source
Shyam K Sathanandam - University of
Tennessee. Health Science Center, 848 Adams Avenue, Memphis, TN, 38103. E-mail:
shyam@uthsc.edu.
Abstract
Objectives: The objectives of this study were
to describe the prevalence, mechanisms, and identify risk factors for acute
loss of arterial pulse (LOP) in children who had ultrasound-guided femoral
arterial access (UGFAA) during cardiac catheterization. Background: LOP is a
known complication in children following femoral arterial (FA) access for
cardiac catheterization. The prevalence of LOP requiring treatment ranges between
4% and 8%. Methods: A prospective study was performed including 486 cardiac catheterizations
using UGFAA in children _18 years over a 3 years
period. Ultrasound and Doppler evaluations were performed prior to and at the
end of the procedure. Results: LOP was identified in 33 cases (6.8%) with 23
(4.7%) requiring treatment. For children _6 months, the prevalence of LOP
requiring treatment was 13.6%. FA diameter <3 mm was the only significant
independent predictor for LOP (OR: 8.44, 95% CI: 2.07Š34.5, P< 0.001).
Smaller patient size, number of access attempts, time required for access,
operator experience, sheath size, and length of procedure were not found to be
significant predictors. Children with LOP had a greater percentage decrease in
vessel diameter (median 62% vs 18%, P< 0.001) compared to those without LOP.
FA thrombus was diagnosed only in 9 patients (27% of those with LOP).
Conclusions: The prevalence of LOP requiring treatment is 4.7% when UGFAA is used
during pediatric cardiac catheterizations. Arterial spasm was more common than thrombus
as a cause of LOP. FA diameter <3 mm was the only independent predictor for
LOP in this carefully designed prospective study.