Bail-Out Stent Graft Implantation for Wire Perforation of an Axillary Artery Branch

Fukui, Tomoki; Ogasawara, Nobuyuki

doi:10.14503/thij-22-8082

Cited by 1 publication

(1 citation statement)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In elective procedures, we think that if the AAA is not obtained from the second attempt, it is advisable to stop the intervention and try a couple of days later, reducing the odds of vascular injuries. The axillary approach is not risk-free and potential complications may occur as in any other arterial access ( 29 – 31 ). We observed that serious vascular complications occurred mainly in very low birth weight neonates with borderline-sized axillary arteries.…”

Section: Discussionmentioning

confidence: 99%

Systematic approach to obtain axillary arterial access for pediatric heart catheterizations

Haddad,

Karmustaji,

Alloush

et al. 2024

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%