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Accessing Femoral Arteries Less than 3 mm in Diameter is Associated with Increased Incidence of Loss of Pulse Following Cardiac Catheterization in Infants

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Abstract

To evaluate whether avoidance of a risk factor associated with loss of pulse (LOP) following femoral artery (FA) catheterization in infants identified from previous study, was associated with decreased incidence of LOP during a prospective evaluation. Since initiation of routine ultrasound guided femoral arterial access (UGFAA) for infants undergoing catheterization in Jan 2003–Dec 2011 (Period-1), our incidence of LOP had stayed steady. Prospective evaluation between Jan 2012–Dec 2014 (Period-2), identified FA-diameter < 3 mm as risk factor for LOP. Between Jan 2015–Dec 2018 (Period-3), an initiative to avoid UGFAA for FA-diameter < 3 mm was implemented to determine whether that led to a decreased incidence of LOP. FA-diameter was measured prior to USGFAA and ratio of outer diameter of arterial sheath to luminal diameter of cannulated artery (OD/AD ratio) was calculated during Periods-2 and 3. The incidence and risk factors for LOP were assessed during the three periods. FA-access rates dropped significantly during Period-3 (56.7% vs. 93.8% and 90.4% during Periods-1 and 2, respectively, p < 0.001). Incidence of LOP in Period-3 decreased to 2.7% compared to 12.5% (Period-1) and 17.4% (Period-2) (p < 0.001). By multivariate analysis, FA size < 3 mm and an OD/AD ratio > 40% were the only significant independent predictors for LOP (OR 6.48, 95% CI 2.3–11.42, p < 0.001 and OR 4.16, 95% CI 1.79–8.65, p < 0.01, respectively). Access of femoral artery < 3 mm and OD/AD ratio > 50% are associated with increased incidence of LOP. Avoidance of these factors may help decrease complications in infants undergoing cardiac catheterizations.

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This study did not receive any funding support.

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Authors and Affiliations

  1. Department of Pediatrics, University of Tennessee Health Science Center, 49 N Dunlap Ave, FOB #348, Memphis, TN, 38103, USA

    Sachin Tadphale, Thomas Yohannan, Travis Kauffmann, B. Rush Waller & Shyam Sathanandam

  2. Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, USA

    Vinod Maller & Vijaykumar Agrawal

  3. Le Bonheur Children’s Hospital, Memphis, TN, USA

    Hannah Lloyd

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  1. Sachin Tadphale
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  2. Thomas Yohannan
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  3. Travis Kauffmann
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  4. Vinod Maller
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  5. Vijaykumar Agrawal
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  6. Hannah Lloyd
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  7. B. Rush Waller
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  8. Shyam Sathanandam
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Correspondence to Sachin Tadphale.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Tadphale, S., Yohannan, T., Kauffmann, T. et al. Accessing Femoral Arteries Less than 3 mm in Diameter is Associated with Increased Incidence of Loss of Pulse Following Cardiac Catheterization in Infants. Pediatr Cardiol 41, 1058–1066 (2020). https://doi.org/10.1007/s00246-020-02357-4

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  • DOI: https://doi.org/10.1007/s00246-020-02357-4

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