Coarctação da Aorta em Crianças com Menos de 25 kg: Tratamento Percutâneo por Punção da Artéria Axilar

Abstract

Background: Percutaneous treatment of aortic coarctation is the method of choice in children over 6 months of age and without aortic arch hypoplasia. However in patients less than 25 kg the classical access route (femoral) may pose a problem, especially in cases of stenting, due to the size of the size of the introducers. The objective of this study was to report our experience with the axillary artery approach for the percutaneous treatmentof patients with aortic coarctation weighing less than 25 kg. Methods: The arterial puncture was performed with a 21 G needle, with the arm abducted at 90°, and a 0.014 inch guidewire was positioned in the descending aorta. A 5 F × 7 cm pediatric introducer was initially used for the procedure and whenever required, it was replaced in a larger one. Manual-compression hemostasis was performed after the intervention. Results: Ten children were treated, eight with residual and two with native coarctation, mean age was 51.1 ± 30.8 months and weight 15.8 ± 5.8 kg. Puncture was performed in all cases without technical difficulty and the median introducer size was 7 F. Eight stents were implanted in eight patients and two patients were only treated by balloon angioplasty. Technical success was observed in all patients. After removal of the introducer, there was no permanent pulse loss and one patient had a small local hematoma. Conclusions: In our experience the axillary artery approach for percutaneous treatment of patients with aortic coarctation proved to be a safe and effective alternative in patients weighing less than 25 kg.

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

“…Previously, Coimbra et al reported the data of coarctation of the aorta patients who weighed less than 24 kg and were treated with a percutaneous axillary artery approach. 5 According to this report, eight patients were treated with stent placement, and all procedures were successfully completed via the axillary artery without technical difficulty. Also, after sheath removal, no pulse loss was observed, and only one small haematoma developed, which did not require transfusion.…”

“…3 In the current literature, percutaneous stent placement via the axillary artery was performed in limited cases of coarctation of the aorta, particularly in those with re-coarctation of the aorta. [4][5][6] Thus, we hereby present the first case of a patient who had a successful percutaneous stent placement via trans-axillary access in our center.…”