Emerging predictors of femoral artery occlusion after pediatric cardiac catheterization

Abstract

Long 3 , feng tang 2 & Lei Li 2* the objective was to review the prevalence of femoral artery occlusion (fAo) after cardiac catheterization in children up to 12 years old from two centers in China and identify its related risk factors. After collecting clinical data from patients who had undergone pediatric cardiac catheterization, univariate and multivariate analysis were used to evaluate the correlations between fAo and clinical factors, including sex, age, height, weight, sheath size, operation time, therapeutic strategy, sheath/age, sheath/height and sheath/weight. the Roc curve was also used to assess the influence of risk factors to predict FAO. FAO occurred in 19 (0.9%) out of 2,084 children following cardiac catheterization. patients with younger age, lower height, longer operation time, electrophysiological (ep) diagnosis or/and therapy for arrhythmias, higher Sheath/Age, higher Sheath/ Height and higher Sheath/Weight ratios had higher risk for fAo compared to their respective control groups (p < 0.05). In the multivariate analysis, sheath/age and operation time were independent risk factors for FAO. Patients with operation time > 77.5 min or sheath/age > 0.5334 had a significantly higher risk for FAO. Operation time and sheath/age were confirmed as significant and independent risk factors associated with FAO. Operation time > 77.5 min and sheath/age > 0.5334 could effectively predict high risk of fAo after pediatric cardiac catheterization. Percutaneous cardiac catheterization in children has been widely accepted since 1962 1-3 , although it is an invasive procedure with several associated complications. Femoral artery occlusion (FAO) is one of the most common relevant complications with reported incidences of 0.7-11.4% in children 4-12. A variety of relevant factors have been identified for FAO 7,10,12-14 , including age, weight, cyanosis, size of needle and sheath, puncture frequency, number of procedural catheter changes and total procedure time. However, there remains uncertainty as to precise risk factors since publications represent simple case reports and different study designs and criteria. Furthermore, the literature lacks many large cohort studies which would allow calculation of the incidence of FAO and related risk factors after pediatric cardiac catheterization in China. The objective of this study was to review the prevalence of FAO in children up to 12 years old after cardiac catheterization and identify risk factors associated with FAO in two centers. Materials and methods Materials. A database of 2,084 pediatric cardiac catheterization procedures performed via femoral artery cannulation at the First Hospital of Tsinghua University (Beijing Huaxin hospital) and Beijing Anzhen Hospital of Capital Medical University during the period August 1, 2009, through September 30, 2016 was reviewed in this study. Patients who had undergone the procedure were 12 years of age or younger. Cardiac catheterizations via venous approach alone had been excluded. Ultrasound guided puncture and closure devic...

Anesthesia management of interventional cardiac catheterization for pulmonary atresia with intact ventricular septum (PAIVS) and critical pulmonary stenosis (CPS): a retrospective analysis

“…A study by Tadphale et al suggested that a diameter of less than 3 millimeters in the femoral artery and a ratio of sheath outer diameter to vascular lumen diameter greater than 50% are associated with an increased risk of experiencing palpable disappearance of femoral artery pulsation at the end of surgery [26]. Multiple studies have shown that low body weight, larger arterial sheath diameter, and longer surgical time are independent risk factors for femoral artery injury [27]. Alexander et al indicated that the use of ultrasound guidance in pediatric cardiac catheterization can reduce the incidence of loss of arterial pulse (LOP) requiring treatment [28].…”

Transcatheter Occlusion of a Giant Coronary Artery Fistula in a Neonate

“…Known complications of trans-catheter occlusion of coronary artery fistulas include residual shunt due to incomplete closure, myocardial ischemia due to closure of side branches of peripheral normal coronary artery, coil migration and embolization in the right ventricular system, transient ST changes on electrocardiograms, and atrioventricular block [ 7 ]. In addition, there is a significant risk of complication at the site of arterial puncture in infants weighing less than 4 kg [ 11 ]. The risk of complication is high in the first 6 months of life, and 0.23% of deaths are reported in neonates [ 12 ].…”