title: Transient flow response after femoral artery catheterization for diagnostic neuroangiography in infants and children: Doppler US assessment of the ipsilateral femoral artery.
abstract: BACKGROUND
  Hemodynamic changes in the distal arteries during transfemoral catheterization in children have not been documented.
  
  
  OBJECTIVE
  To evaluate arterial flow changes of the lower extremities ipsilateral to the puncture site using Doppler US during transfemoral cerebral angiography in children.
  
  
  METHODS
  Twenty-seven children who underwent transfemoral cerebral angiography at our institution between April 2013 and August 2013 compose our study population. Doppler US was performed to evaluate diameters and peak systolic velocities of the common femoral artery and superficial femoral artery before and after femoral sheath insertion. Children were classified into three groups based on the spectral waveform changes of the superficial femoral artery after femoral sheath insertion. Thereafter, one-way ANOVA followed by the Bonferroni post-hoc comparisons test were performed to compare values among the groups.
  
  
  RESULTS
  Mean common femoral artery and superficial femoral artery baseline diameters were 4.10 mm and 3.32 mm, and mean baseline peak systolic velocities were 218.26 and 166.51 cm/s, respectively. Fourteen of 27 children showed persistent triphasic flow in the superficial femoral artery (group 1); 7 children showed altered flow of biphasic (n = 3) or monophasic (n = 4) waveforms (group 2); and 6 children showed pulsus tardus et parvus pattern (group 3) after femoral sheath insertion. Mean baseline diameter of the common femoral artery and mean subtracted value between common femoral artery and femoral sheath size were significantly smaller in group 3 than the other groups. Size discrepancy between common femoral artery and femoral sheath was <1 mm in all cases of group 3. Superficial femoral artery diameter and peak systolic velocity significantly decreased after femoral sheath insertion in group 3 compared to groups 1 and 2. A significant skin temperature drop after sheath insertion in the ipsilateral lower extremity was noted in group 3 (-1.83°C), compared to groups 1 and 2 (+0.42 and -0.86°C, respectively).
  
  
  CONCLUSIONS
  Changes in the spectral waveforms of superficial femoral arteries frequently occur in children during transfemoral cerebral angiography (13/27, 48%). Significant arterial flow disturbance was noted on Doppler US in children with a common femoral artery <1 mm larger than the femoral sheath diameter.
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Seong Ho
authors.initials: SH
authors.lastname: Kim
authors.forename: Young Hun
authors.initials: YH
authors.lastname: Choi
authors.forename: Jung-Eun
authors.initials: JE
authors.lastname: Cheon
authors.forename: Su-Mi
authors.initials: SM
authors.lastname: Shin
authors.forename: Hyun-Hae
authors.initials: HH
authors.lastname: Cho
authors.forename: So Mi
authors.initials: SM
authors.lastname: Lee
authors.forename: Sun Kyoung
authors.initials: SK
authors.lastname: You
authors.forename: Woo Sun
authors.initials: WS
authors.lastname: Kim
authors.forename: In-One
authors.initials: IO
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D001783:Blood Flow Velocity / Q000502:physiology*; D002406:Catheterization, Peripheral / Q000379:methods*; D002533:Cerebral Angiography / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging* / Q000502:physiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler / Q000379:methods*