title: The early and mid-term fate of the axillary artery following axillary artery cut-down and cardiac catheterization in infants and young children.
abstract: OBJECTIVE
  To study the early and mid-term vascular complications of axillary artery catheterization in children <2 years by clinical and ultrasound examination.
  
  
  BACKGROUND
  Femoral arterial access for cardiac catheterization in young children is associated with significant morbidity. Early complications of axillary artery catheterization have been reported but no long-term vascular follow-up data are available.
  
  
  METHODS
  Prospective case-control study using standard vascular ultrasound techniques to examine the upper limbs in study participants (n = 10).
  
  
  RESULTS
  In total, 23% of axillary artery catheterizarions (56 procedures in 54 patients) resulted in acute arterial insufficiency requiring heparin. Of the survivors under follow-up (n = 33), none had symptoms of chronic arterial insufficiency. At a median follow-up of 8 years postprocedure, three out of the ten study participants had a weak brachial pulse in the test arm but no significant difference in arm measurements. Color Doppler revealed occlusion of the axillary artery in the test arm with collateralization in three patients. The brachial peak systolic velocity (V(max)) was significantly lower in the test arm than the control arm of all the patients with a mean difference of 30 cm/sec (P = 0.007).
  
  
  CONCLUSIONS
  Our study is the first to examine the long-term vascular sequelae of axillary artery catheterization using ultrasound examination and highlights the importance of careful surveillance of vascular access sites. Although axillary artery cut-down for cardiac catheterization in infants and young children does not appear to result in clinical signs of chronic arterial insufficiency, we demonstrate clear evidence of flow abnormalities on vascular ultrasound which are of uncertain long-term significance.
authors.affiliation: Department of Paediatric Cardiology, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, United Kingdom. sangeetha.viswanathan@gmail.com
authors.forename: Sangeetha
authors.initials: S
authors.lastname: Viswanathan
authors.forename: Rosemary
authors.initials: R
authors.lastname: Arthur
authors.forename: J A
authors.initials: JA
authors.lastname: Evans
authors.forename: John
authors.initials: J
authors.lastname: Truscott
authors.forename: J D R
authors.initials: JD
authors.lastname: Thomson
authors.forename: J L
authors.initials: JL
authors.lastname: Gibbs
mesh_terms: D000208:Acute Disease; D000925:Anticoagulants / Q000627:therapeutic use; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D001366:Axillary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001783:Blood Flow Velocity; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods*; D003097:Collateral Circulation; D004739:England / Q000453:epidemiology; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D012039:Regional Blood Flow; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D034941:Upper Extremity / Q000098:blood supply*; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D006493:Heparin