Background: Transradial intervention is increasingly replacing approaches, due to lower access complications, cost, and improved patient satisfaction. There are limited supporting data in the pediatric literature, largely due to concerns regarding arterial size. The objective of this study was to measure radial artery diameters in children across all age groups, to establish reference ranges for clinical use. Methods: This prospective study was carried out in children ≤18 years of age who underwent ultrasound for measuring radial artery diameters from November 2018 to November 2019. The cohort was divided into age groups: ≤2, 3 to 5, 6 to 8, 9 to 11, 12 to 14, 15 to 18 years, and into pre- and post-adolescent (≥12 years) groups. Results: One hundred thirty-four children (M:F=63:71) were included, with bilateral measurements resulting in 268 data points. Mean age was 8.9±5.8 years (range, 29 days to 18 years), mean weight 37.2±27.5 kg (range, 1.7–149.1 kg). Mean-corrected radial artery diameter was 1.86±0.44 mm. There was no difference in arterial diameters between males and females (1.90±0.50 versus 1.81±0.53 mm; P =0.73) or between right and left sides (1.87±0.46 versus 1.87±0.47, P =0.98). There was a strong correlation of diameter with age (R=0.75; P <0.00001) and weight (R=0.74; P <0.00001). There was linear increase in arterial growth rates in early childhood, followed by plateauing to adult sizes in adolescents. Inter-reader agreement was 0.95. Conclusions: We provide a reference range for radial artery diameters across childhood ages, which can be used for decision-making. This could be the basis for designing a trial of transradial intervention in children, to establish clinical safety and efficacy.
Purpose: To evaluate the safety and efficacy of long vascular sheaths for transfemoral neuroendovascular procedures in children.Materials and Methods: A retrospective evaluation of transfemoral neuroendovascular procedures in children <18 years, using long sheaths was undertaken analyzing procedure type, fluoroscopic times, technical success, access site and systemic complications. Twenty-seven consecutive procedures were included over a two-year period. Mean age was 8.4 years (standard deviation [SD] 6.3) (range 17.0 months–16.3 years).Results: Patients were 44% female and mean weight was 35.0 kg (SD 22.8) (range 9.8–72.2 kg). A third of the procedures were performed in ≤15 kg children. The most common procedure was for embolization (n=13, 48.1%) and the most common indication was dual microcatheter technique (52%). The most common device used was the 5 Fr Cook Shuttle sheath. Mean fluoroscopy time was 61.9 minutes (SD 43.1). Of these procedures, 93% were technically successful. Femoral vasospasm, when present, was self-limiting. Complications (3/27, 11.1%) included groin hematoma (n=1), neck vessel spasm that resolved with verapamil (n=1), and intracranial thromboembolism (n=1), with no significant difference between the ≤15 kg and >15 kg subcohorts. There were no aorto-femoro-iliac or limb-ischemic complications.Conclusion: Long vascular sheaths without short femoral sheaths can be safely used for pediatric neuroendovascular procedures as they effectively increase inner diameter access without increasing the outer sheath diameter. This property increases the range of devices used and intracranial techniques that can be safely performed without arterial compromise, thus increasing the repertoire of the neurointerventionalist.
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