title: Ultrasound-guided transaxillary access for diagnostic and interventional arteriography in children.
abstract: OBJECTIVE
  Most pediatric arteriograms are obtained from a femoral approach; alternative access sites are sometimes needed. Transaxillary arteriography is an established procedure in adults. The purpose of this study was to establish the feasibility and safety of this procedure in children.
  
  
  METHODS
  All children who underwent arteriography involving axillary access during a 10-year period were reviewed for demographic details, indications, technical aspects of the procedure, and complications. Twenty-five procedures were performed in 19 children aged between 7 days and 15 years (median, 4.8 years). The children weighed between 2.6 and 47 kg (median, 15 kg). Indications for use of the axillary artery were absolute (including aortic or bilateral iliac artery occlusion) in 15 (60%) and relative (including more favorable angle for thoracic or abdominal intervention) in 10 (40%). Two procedures (8%) were purely diagnostic arteriography procedures.
  
  
  RESULTS
  Transaxillary access was successful in all cases. The largest sheath used (7-F) had an outer diameter of 2.7 mm. One child died of a postoperative complication unrelated to the arterial access. There were no neurologic or bleeding complications related to the access site. Two access site complications (8%) occurred-one pseudoaneurysm and one axillary artery dissection-but neither resulted in permanent adverse sequelae.
  
  
  CONCLUSIONS
  Ultrasound-guided transaxillary access is feasible for arteriography in children when femoral access is impossible or unfavorable for technical reasons. Although major complications are unlikely, this study does not exclude the possibility of subtle postoperative nerve injury.
authors.affiliation: Department of Radiology, Great Ormond Street Hospital, London WC1N 3JH, United Kingdom. derek_roebuck@hotmail.com
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Roebuck
authors.forename: Kani
authors.initials: K
authors.lastname: Vendhan
authors.forename: Alex M
authors.initials: AM
authors.lastname: Barnacle
authors.forename: Stefan
authors.initials: S
authors.lastname: Brew
authors.forename: Clare A
authors.initials: CA
authors.lastname: McLaren
mesh_terms: D000792:Angiography / Q000379:methods*; D001365:Axilla / Q000000981:diagnostic imaging*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D015641:Radiography, Interventional / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods*