title: Ultrasound-guided femoral arterial access in pediatric cardiac catheterizations: A prospective evaluation of the prevalence, risk factors, and mechanism for acute loss of arterial pulse.
abstract: OBJECTIVE
  The objectives of this study were to describe the prevalence, mechanisms, and identify risk factors for acute loss of arterial pulse (LOP) in children who had ultrasound-guided femoral arterial access (UGFAA) during cardiac catheterization.
  
  
  BACKGROUND
  LOP is a known complication in children following femoral arterial (FA) access for cardiac catheterization. The prevalence of LOP requiring treatment ranges between 4% and 8%.
  
  
  METHODS
  A prospective study was performed including 486 cardiac catheterizations using UGFAA in children ≤18 years over a 3 years period. Ultrasound and Doppler evaluations were performed prior to and at the end of the procedure.
  
  
  RESULTS
  LOP was identified in 33 cases (6.8%) with 23 (4.7%) requiring treatment. For children ≤6 months, the prevalence of LOP requiring treatment was 13.6%. FA diameter <3 mm was the only significant independent predictor for LOP (OR: 8.44, 95% CI: 2.07-34.5, P < 0.001). Smaller patient size, number of access attempts, time required for access, operator experience, sheath size, and length of procedure were not found to be significant predictors. Children with LOP had a greater percentage decrease in vessel diameter (median 62% vs 18%, P < 0.001) compared to those without LOP. FA thrombus was diagnosed only in 9 patients (27% of those with LOP).
  
  
  CONCLUSIONS
  The prevalence of LOP requiring treatment is 4.7% when UGFAA is used during pediatric cardiac catheterizations. Arterial spasm was more common than thrombus as a cause of LOP. FA diameter <3 mm was the only independent predictor for LOP in this carefully designed prospective study. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee.
authors.forename: John
authors.initials: J
authors.lastname: Alexander
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee.
authors.forename: Thomas
authors.initials: T
authors.lastname: Yohannan
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee.
authors.forename: Iman
authors.initials: I
authors.lastname: Abutineh
authors.affiliation: Department of Radiology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee.
authors.forename: Vijaykumar
authors.initials: V
authors.lastname: Agrawal
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee.
authors.forename: Hannah
authors.initials: H
authors.lastname: Lloyd
authors.affiliation: Department of Biostatistics, Harvard Medical School, Boston, Massachusetts.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee.
authors.forename: B Rush
authors.initials: BR
authors.lastname: Waller
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee.
authors.forename: Shyam
authors.initials: S
authors.lastname: Sathanandam
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007223:Infant; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D011674:Pulse; D011677:Punctures; D018570:Risk Assessment; D012307:Risk Factors; D013714:Tennessee / Q000453:epidemiology; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D018084:Ultrasonography, Interventional; D014661:Vasoconstriction
keywords: arterial access; femoral artery size; pulse loss