Use of carotid and axillary artery approach for stenting the patent ductus arteriosus in infants with ductal-dependent pulmonary blood flow: A multicenter study from the congenital catheterization research collaborative

Catheter Cardiovasc Interv. 2020 Mar 1;95(4):726-733. doi: 10.1002/ccd.28631. Epub 2019 Dec 9.

Abstract

Background: Carotid artery (CA) and axillary artery (AA) access are increasingly used for transcatheter stenting of the patent ductus arteriosus (PDA), although reports are limited.

Methods: The Congenital Catheterization Research Collaborative (CCRC) reviewed multicenter data from infants who underwent PDA stenting via the CA or AA approach from 2008 to 2017, and compared outcomes to those of infants undergoing PDA stenting via the femoral artery (FA) approach. Post-procedure ultrasound (US) imaging was reviewed.

Results: Forty-nine infants underwent PDA stenting from the CA (n = 43) or AA (n = 6) approach, compared with 55 infants who underwent PDA stenting from the FA approach. The PDA was the sole pulmonary blood flow (PBF) source in 61% of infants in the CA/AA cohort, compared with 33% of the FA cohort (p < .01). Ductal tortuosity for CA/AA cohort was Type I (straight) in 10 (20%), Type II (one turn) in 17 (35%), and Type III (multiple turns) in 22 (45%) infants and reflected a greater degree of tortuosity when compared to the FA cohort (p < .01). In 17 infants with CA/AA approach, the "flip technique" was used, and was associated with shorter procedure times for highly tortuous PDA (Type III) patients. Rates of procedural complications were similar across access sites. Most common complications were access site injury (thrombus or bleeding) and stent malposition. No complications were specifically related to the "flip technique."

Conclusions: Use of CA and AA approach for PDA stenting was found to be more commonly employed in sole source PBF and highly tortuous PDAs. Procedural modifications such as the "flip technique" may lead to shorter procedure times. CA and AA approaches are associated with a similar burden of procedural or late complications. Post-procedural surveillance of the CA and AA is suggested, given the incidence of vascular findings on US.

Keywords: PDA stenting; axillary access; carotid access.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Axillary Artery* / diagnostic imaging
  • Cardiac Catheterization / adverse effects
  • Cardiac Catheterization / instrumentation*
  • Carotid Arteries* / diagnostic imaging
  • Catheterization, Peripheral* / adverse effects
  • Ductus Arteriosus, Patent / diagnostic imaging
  • Ductus Arteriosus, Patent / physiopathology
  • Ductus Arteriosus, Patent / therapy*
  • Female
  • Femoral Artery* / diagnostic imaging
  • Humans
  • Infant, Newborn
  • Male
  • Palliative Care*
  • Pulmonary Circulation*
  • Punctures
  • Retrospective Studies
  • Stents*
  • Treatment Outcome
  • Ultrasonography, Interventional
  • United States