Iliofemoral arterial complications of balloon angioplasty for systemic obstructions in infants and children.

Abstract

The medical and radiological records of 64 consecutive infants and children who underwent transfemoral balloon dilation of the aorta or aortic valve were reviewed to determine the incidence, nature, and post-treatment outcome of acute iliofemoral complications. 29), and magnetic resonance imaging (three of 29). Of eight patients, three with arterial disruption had acute hypotension requiring transfusion and immediate surgery; the other five had absent pedal pulses after the procedure. Of these five, three developed bleeding during thrombolytic therapy and underwent surgical exploration, and two were diagnosed by angiography after ineffective thrombolytic therapy. Angiography in three patients with iliac artery avulsion showed tapered occlusion in two and an aneurysm in one. In patients with iliofemoral thrombosis, angiography showed occlusion from the puncture site to the origin of the external iliac artery. Eleven patients (17% of the entire group and 38% of the group with acute iliofemoral complications) had reduced or absent pedal pulses at the time of discharge. A significant correlation was found between increased incidence of iliofemoral thrombosis and disruption (as well as abnormal pedal pulses at hospital discharge) and low patient weight. (Circulation 1990;82:1697-1704 Cmomplications involving the iliac and femoral arteries occur relatively frequently after diagnostic catheter procedures in infants and children, especially in those weighing less than 15 kg.1-6 Long-term sequelae of iliofemoral thrombosis, including lower-extremity growth disturbance, have resulted in some patients, although attempts to determine the incidence of such complications have yielded varying results.7-15 To avoid these complica-

Percutaneous Common Carotid Artery Access for Pediatric Interventional Cardiac Catheterization

“…13 Recent data suggest that a weight of <4 kg poses an added risk of thrombosis from femoral arterial catheterization. 14,15 In the study by Glatz et al, 14 the rate of acute arterial occlusion after femoral artery catheterization infants <4 kg was 20% to 30%, and (1) was often clinically silent, (2) correlated directly with sheath size, and (3) Figure 1.…”

Aortic Wall Injury as a Complication of Neonatal Aortic Valvuloplasty

“…10 -12 Femoral vascular injuries constitute the majority of procedural complications and range from thrombotic obstruction with diminution of distal pulses to catastrophic disruption of access vessels requiring surgical intervention. 9,[12][13][14][15] Although mentioned in animal experiments and in 2 early cases, 16 aortic wall injury has gone almost unmentioned in subsequent series. When Egito et al 12 noted aortic intimal flaps in 2 patients, they speculated that technical modifications would reduce or eliminate the potential for this complication.…”

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

“…608 Hurwitz et al 609 reported complete occlusion of the femoral artery with extensive collateralization as diagnosed by angiography in 4 of 48 patients (8%) who were recatheterized 6 months to 9 years after their initial procedure. Burrows et al 610 demonstrated that obstructive lesions of the iliofemoral arteries are common after transfemoral balloon angioplasty of arch obstructions (58%). Catheter size and manipulation were the main contributing factors.…”