Doppler evaluation of femoral arteries in children after aortic balloon valvuloplasty or coarctation balloon angioplasty

Abstract

To assess long-term femoral artery complications after aortic balloon valvuloplasty or coarctation balloon angioplasty, we examined 19 children who were 3 weeks to 21 years old (mean 7.6 years) at the time of catheterization. Two-dimensional and Doppler echocardiographic examinations of the common, superficial, and deep femoral arteries were performed at an average of 2.0 years after balloon dilatation. Pulsatility index (PI) was calculated as the maximum velocity minus the minimum velocity divided by the mean velocity. No patient was suspected clinically of having peripheral arterial disease prior to the echocardiographic examination. Fourteen patients had normal femoral arteries. Of these, 10 had normal twodimensional and Doppler echocardiographic examinations of both femoral arteries. These patients had triphasic flow patterns (forward in systole, reverse in early diastole, forward in middiastole) and Pls of 3.7-41.6 (mean 9.5). Four of the 14 normal patients had abnormal pulsed Doppler examinations showing continuous forward flow and low PIs (1.7-3.5) reflecting residual coarctation (10-30 mmHg gradients). Five patients had abnormal femoral arteries. Of these, two had no visible obstruction by two-dimensional echocardiography and color-flow imaging but had abnormal pulsed Doppler patterns (continuous forward flow and low Pls of 2.5 and 2.9) only on the side of the balloon catheter insertion. Three of the five abnormal patients had visible obstructions by two-dimensional echocardiography and color-flow imaging and had abnormal pulsed Doppler patterns (continuous forward flow and low Pls from 1.1-3.6). One of these three had bilateral occlusions of the common femoral arteries with multiple collateral vessels; the second had occlusion of the right common femoral artery; and the third had 1-2-cm long severely narrowed segments in both common femoral arteries. All three children were <1 year old at the time of catheterization and had balloon catheter insertions in the affected arteries.Echocardiography provides a useful technique for detection of clinically unsuspected but significant arterial obstruction after balloon dilatation. Thus, echocardiographic examinations of the femoral arteries should be performed on all children after balloon dilatation, particularly those <1 year old at the time of the procedure.

Evaluation of carotid artery access in comparison with femoral artery access in neonatal percutaneous stenting of ductus arteriosus

“…Doppler ultrasound examinations on follow-up were performed at a median of 11 (7-17.75) months after the intervention for the carotid artery access cases and a mean of 17 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) months following patent ductus arteriosus stenting for the femoral artery group. In the femoral artery access, two had mild luminal narrowing and one case had severe stenosis at the access site while with the carotid artery group, only one case had mild stenosis of the access artery.…”

“…Although the femoral artery approach is the traditional access, complications following femoral artery access have been explored by various studies and have varied from 2.9to 39%. [14][15][16] Vermilion et al reported that children under 1 year of age have a higher risk of developing arterial obstructions after balloon dilation of left obstructive lesions using the femoral approach. 15 Cohn et al reported 10-fold higher complications risk for children less than 4 months old.…”

“…[14][15][16] Vermilion et al reported that children under 1 year of age have a higher risk of developing arterial obstructions after balloon dilation of left obstructive lesions using the femoral approach. 15 Cohn et al reported 10-fold higher complications risk for children less than 4 months old. 17 On using ultrasound assessment for 120 arterial catheterisation procedures, arterial thrombosis was detected in 16% of patients less than 10 kg.…”

Perspective Chapter: Transcatheter Interventions in the Management of Aortic Valve Stenosis

“…Neonatal BAV may be undertaken in a manner similar to that described above [5,[57][58][59][60]. However, injury to the femoral artery [8,61] is of concern. Consequently, other routes of access, namely, subscapular [62], axillary [63], carotid [64], and umbilical [65] arterial, anterograde femoral venous [66,67], and umbilical venous [9,15] routes have been tried.…”

Balloon Dilatation in the Management of Congenital Obstructive Lesions of the Heart: Review of Author’s Experiences and Observations – Part II

“…While percutaneous femoral arterial route is the most frequently used method for executing BAV, there is a concern for injury to the femoral artery [47,48], chiefly in neonates and young infants. Consequently, other approaches, namely, carotid artery [49], axillary artery [50], umbilical artery [51], subscapular artery [52], anterograde femoral vein [53,54], and umbilical vein [55,56] routes have been experimented.…”