title: Addressing challenges in 4 F and 5 F arterial access for neurointerventional procedures in infants and young children.
abstract: BACKGROUND
  Among the technical challenges involved in safely performing neuroendovascular procedures in infants are limitations on the size of femoral arterial access catheters. Restricting groin access to 4 F and 5 F systems constrains the range of procedures that can potentially be performed.
  
  
  RESULTS
  We present here a consecutive series of transfemoral angiographic procedures in children with no permanent and one transient case of groin morbidity related to femoral access. We illustrate two strategies for using 4 F and 5 F systems for interventions in a manner that enables such techniques as balloon assisted coil embolization and the deployment of triaxial catheter systems to be used.
  
  
  CONCLUSIONS
  Extremely low groin morbidity is achievable using rigorous parameters around femoral catheterization in children. With creative approaches to working within the limitations of the access vessel size, complex endovascular neurointerventions are possible, even in the youngest infants.
authors.affiliation: Department of Neurological Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Gross
authors.forename: Darren B
authors.initials: DB
authors.lastname: Orbach
mesh_terms: D000367:Age Factors; D001164:Arteriovenous Fistula / Q000628:therapy; D021721:Balloon Occlusion / Q000379:methods; D002550:Cerebral Veins / Q000002:abnormalities; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic / Q000379:methods*; D005263:Femoral Artery; D006801:Humans; D007223:Infant; D002538:Intracranial Arteriovenous Malformations / Q000628:therapy; D011859:Radiography; D012189:Retrospective Studies; D062666:Vascular Access Devices
keywords: Angiography; Balloon; Catheter; Pediatrics; Technique