Percutaneous Axillary Artery Access Facilitates Complex Cardiac Procedures in Children
Presenter
Bassel Mohammad Nijres, M.D., FSCAI, University of Iowa Stead Family Children’s Hospital, Iowa City, IA
Bassel Mohammad Nijres, M.D., FSCAI, University of Iowa Stead Family Children’s Hospital, Iowa City, IA, Osman K Yousafzai, MD, Baylor College of Medicine/Texas Children's Hospital, Houston, TX and Athar M. Qureshi, M.D., FSCAI, Texas Children's Hospital, Houston, TX
Keywords: Vascular Access, Management, and Closure
Background:
Children with complex congenital heart disease/other lesions often require alternative arterial access. Axillary artery access may facilitate these complex procedures. We aimed to assess the efficacy and safety of the use of percutaneous axillary artery access in children undergoing cardiac catheterization procedures.
Methods:
Medical records of children in whom percutaneous axillary artery access was attempted between 12/2014-12/2019 at Texas Children’s Hospital were reviewed. Percutaneous axillary artery access was performed with the use of ultrasound and fluoroscopy, to avoid arterial compromise/damage to the brachial plexus.
Results:
respectively. Procedures performed included ductus arteriosus interventions (n=15), coarctation of aorta interventions (n=2), left pulmonary artery recanalization through modified Blalock Taussig (mBT) shunt (n=2), occluded mBT shunt recanalization (n=1), aortopulmonary collateral embolization (n=1), ventricular septal defect creation and stenting (n=1), Impella device placement (Abiomed, Danvers, MA) (n=1), renal artery stent placement (n=1), superior mesenteric artery and celiac artery angiography (n=1), and coronary angiography (n=1). No acute complications were encountered. Follow up ultrasound was obtained after 14/26 procedures. Axillary access related complications occurred in 5/26 (19%) procedures. These included axillary artery thrombosis (n=3) that were all treated medically with full resolution and pseudoaneurysm formation (n=2, one requiring ultrasound injection of thrombin and the other spontaneously resolved). At a median follow up of 23.3 (0.25-57) months, there was no clinical documentation of arterial compromise or nerve injury.
Conclusions:
Percutaneous axillary artery access facilitates complex interventions in children. Operators should be aware of the relevant anatomy, and potential complications (in addition to their management) of this procedure, particularly thrombosis and pseudoaneurysm formation.