Ultrasound-guided femoral arterial access in pediatric cardiac catheterizations: A prospective evaluation of the prevalence, risk factors, and mechanism for acute loss of arterial pulse

Catheter Cardiovasc Interv. 2016 Dec;88(7):1098-1107. doi: 10.1002/ccd.26702. Epub 2016 Aug 18.


Objectives: The objectives of this study were to describe the prevalence, mechanisms, and identify risk factors for acute loss of arterial pulse (LOP) in children who had ultrasound-guided femoral arterial access (UGFAA) during cardiac catheterization.

Background: LOP is a known complication in children following femoral arterial (FA) access for cardiac catheterization. The prevalence of LOP requiring treatment ranges between 4% and 8%.

Methods: A prospective study was performed including 486 cardiac catheterizations using UGFAA in children ≤18 years over a 3 years period. Ultrasound and Doppler evaluations were performed prior to and at the end of the procedure.

Results: LOP was identified in 33 cases (6.8%) with 23 (4.7%) requiring treatment. For children ≤6 months, the prevalence of LOP requiring treatment was 13.6%. FA diameter <3 mm was the only significant independent predictor for LOP (OR: 8.44, 95% CI: 2.07-34.5, P < 0.001). Smaller patient size, number of access attempts, time required for access, operator experience, sheath size, and length of procedure were not found to be significant predictors. Children with LOP had a greater percentage decrease in vessel diameter (median 62% vs 18%, P < 0.001) compared to those without LOP. FA thrombus was diagnosed only in 9 patients (27% of those with LOP).

Conclusions: The prevalence of LOP requiring treatment is 4.7% when UGFAA is used during pediatric cardiac catheterizations. Arterial spasm was more common than thrombus as a cause of LOP. FA diameter <3 mm was the only independent predictor for LOP in this carefully designed prospective study. © 2016 Wiley Periodicals, Inc.

Keywords: arterial access; femoral artery size; pulse loss.

MeSH terms

  • Adolescent
  • Age Factors
  • Arterial Occlusive Diseases / diagnostic imaging
  • Arterial Occlusive Diseases / epidemiology*
  • Arterial Occlusive Diseases / physiopathology
  • Arterial Occlusive Diseases / therapy
  • Cardiac Catheterization / adverse effects*
  • Cardiac Catheterization / methods
  • Catheterization, Peripheral / adverse effects*
  • Catheterization, Peripheral / methods
  • Child
  • Child, Preschool
  • Female
  • Femoral Artery / diagnostic imaging*
  • Femoral Artery / physiopathology
  • Humans
  • Infant
  • Male
  • Prevalence
  • Prospective Studies
  • Pulse*
  • Punctures
  • Risk Assessment
  • Risk Factors
  • Tennessee / epidemiology
  • Thrombosis / diagnostic imaging
  • Thrombosis / epidemiology*
  • Thrombosis / physiopathology
  • Thrombosis / therapy
  • Treatment Outcome
  • Ultrasonography, Doppler*
  • Ultrasonography, Interventional*
  • Vasoconstriction