Skip to main content

Advertisement

SpringerLink
Log in

Establishing Carotid Seldinger as Routine Access in Infants; Planning, Performance, and Follow-Up Protocols

  • Research
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Percutaneous carotid access (PCA) in infants has been reported in small multicenter cohorts, case reports and wider studies over the last 20 years. Compare outcomes after implementation of a systematic approach to PCA in a single center including an imaging follow-up protocol. Retrospective case–control study of PCA at Children’s Hospital Colorado was performed from January 2013 to December 2022. Seventy-four patients underwent 82 PCAs for cardiac catheterization. The median age (range) was 14 days (1–359), and weight was 3.25-kg (1.9–7.9). Median sheath size was 4-Fr (3.3–6). Seventy-seven interventions performed included PDA stenting, aortic valvoplasty, BTT shunt stenting, and coarctation stenting. Vascular access was performed using a modified 21 g butterfly needle. A protocolized approach was implemented in 2020 reversing the patient head-to-toe orientation on the catheterization table, maintaining intubation and sedation for 4-h during recovery and routine use of a specific vascular ultrasound protocol. Following these changes, time to access significantly improved with no major complications. Before 2020, two access related complications occurred. One requiring surgical vascular repair and one occlusive thrombus. A significant increase in sheath time in post-era was associated with increased case complexity. Longer sheath times were not associated with increased risk of vessel injury or thrombus. No neurological insults were reported. Our experience confirms that PCA is safe and achievable with preserved vessel patency regardless of patient weight or sheath size. A protocolized planning, recovery, and follow-up regimen is recommended to establish safe practice and identify and treat complications as necessary.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

PCA:

Percutaneous carotid access

ACT:

Activated clotting time

RPA:

Right pulmonary artery

LPA:

Left pulmonary artery

CoA:

Coarctation of the aorta

PDA:

Patent ductus arteriosus

References

  1. Cassidy SC, Schmidt KG, Van Hare GF, Stanger P, Teitel DF (1992) Complications of pediatric cardiac catheterization: a 3-year study. J Am Coll Cardiol 19:1285–1293

    Article  CAS  PubMed  Google Scholar 

  2. Bergersen L, Marshall A, Gauvreau K, Beekman R, Hirsch R, Foerster S, Balzer D, Vincent J, Hellenbrand W, Holzer R, Cheatham J, Moore J, Lock J, Jenkins K (2010) Adverse event rates in congenital cardiac catheterization - a multi-center experience. Catheter Cardiovasc Interv 15(75):389–400

    Google Scholar 

  3. Bulbul ZR, Galal MO, Mahmoud E, Narden B, Solymar L, Chaudhary MA, Al Halees ZY (2002) Arterial complications following cardiac catheterization in children less than 10 kg. Asian Cardiovasc Thorac Ann 10:129–132

    Article  PubMed  Google Scholar 

  4. Davenport JJ, Lam L, Whalen-Glass R, Nykanen DG, Burke RP, Hannan R, Zahn EM (2008) The successful use of alternative routes of vascular access for performing pediatric interventional cardiac catheterization. Catheter Cardiovasc Interv 1(72):392–398

    Article  Google Scholar 

  5. Dua JS, Osborne NJ, Tometzki AJ, Martin RP (2006) Axillary artery approach for balloon valvoplasty in young infants with severe aortic valve stenosis: medium-term results. Catheter Cardiovasc Interv 68:929–935

    Article  PubMed  Google Scholar 

  6. Azzolina G, Eufrate SA, Allella A (1973) New approach to catheterization of the heart in infants and children. Br Heart J 35:643–646

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Fischer DR, Ettedgui JA, Park SC, Siewers RD, del Nido PJ (1990) Carotid artery approach for balloon dilation of aortic valve stenosis in the neonate: a preliminary report. J Am Coll Cardiol 15:1633–1636

    Article  CAS  PubMed  Google Scholar 

  8. Maeno Y, Akagi T, Hashino K, Ishii M, Sugimura T, Takagi J, Suzuki K, Kato H (1997) Carotid artery approach to balloon aortic valvuloplasty in infants with critical aortic valve stenosis. Pediatr Cardiol 18:288–291

    Article  CAS  PubMed  Google Scholar 

  9. Robinson BV, Brzezinska-Rajszys G, Weber HS, Ksiazyk J, Fricker FJ, Fischer DR, Ettedgui JA (2000) Balloon aortic valvotomy through a carotid cutdown in infants with severe aortic stenosis: results of the multi-centric registry. Cardiol Young 10:225–232

    Article  CAS  PubMed  Google Scholar 

  10. Borghi A, Agnoletti G, Poggiani C (2001) Surgical cutdown of the right carotid artery for aortic balloon valvuloplasty in infancy: midterm follow-up. Pediatr Cardiol 22:194–7

    Article  CAS  PubMed  Google Scholar 

  11. Choudhry S, Balzer D, Murphy J, Nicolas R, Shahanavaz S (2016) Percutaneous carotid artery access in infants < 3 months of age. Catheter Cardiovasc Interv 87:757–761

    Article  PubMed  Google Scholar 

  12. Justino H, Petit CJ (2016) Percutaneous common carotid artery access for pediatric interventional cardiac catheterization. Circ Cardiovasc Interv 9:e003003

    Article  PubMed  Google Scholar 

  13. Bauser-Heaton H, Qureshi AM, Goldstein BH, Glatz AC, Nicholson GT, Meadows JJ, Depaolo JS, Aggarwal V, McCracken CE, Mossad EB, Wilson EC, Petit CJ (2020) Use of carotid and axillary artery approach for stenting the patent ductus arteriosus in infants with ductal-dependent pulmonary blood flow: a multicenter study from the congenital catheterization research collaborative. Catheter Cardiovasc Interv 1(95):726–733

    Article  Google Scholar 

  14. Ligon RA, Ooi YK, Kim DW, Vincent RN, Petit CJ (2017) Intervention on surgical systemic-to-pulmonary artery shunts: carotid versus femoral access. JACC Cardiovasc Interv 11(10):1738–1744

    Article  Google Scholar 

  15. Glatz AC, Shah SS, McCarthy AL, Geisser D, Daniels K, Xie D, Hanna BD, Grundmeier RW, Gillespie MJ, Rome JJ (2013) Prevalence of and risk factors for acute occlusive arterial injury following pediatric cardiac catheterization: a large single-center cohort study. Catheter Cardiovasc Interv 1(82):454–462

    Article  Google Scholar 

  16. Ligon RA, Kim DW, Vincent RN, Bauser-Heaton HD, Ooi YK, Petit CJ (2018) Angiographic follow-up of infants and children undergoing percutaneous carotid artery interventions. Catheter Cardiovasc Interv 91:1301–1306

    Article  PubMed  Google Scholar 

  17. Bauser-Heaton H, Qureshi AM, Goldstein BH, Glatz AC, Petit CJ (2019) Use of novel “flip technique” aids in percutaneous carotid artery approach in neonates. JACC Cardiovasc Interv 26(12):1630–1631

    Article  Google Scholar 

Download references

Acknowledgements

None

Funding

No funding was used in this study.

Author information

Authors and Affiliations

  1. Department of Pediatric Cardiology, University of Colorado, Children’s Hospital Colorado, The Heart Center, 13123 E 16th Ave, B100, Aurora, CO, 80045, USA

    Ernesto Mejia, Jenny Zablah, Natalie Soszyn & Gareth J. Morgan

  2. Department of Pediatric Cardiology, Children’s Wisconsin, Milwaukee, WI, USA

    Daniel McLennan

  3. Department of Pediatric Cardiology, University of Iowa, Stead Family Children’s Hospital, Iowa City, IA, USA

    Daniel McLennan & Kamel Shibbani

Authors
  1. Ernesto Mejia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel McLennan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jenny Zablah
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Natalie Soszyn
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kamel Shibbani
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gareth J. Morgan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

DM conceptualized the idea of this investigation and reviewed the main manuscript. EM collected the data and wrote the main manuscript, made all revisions and designed and created all figures and tables. NS data collection and statistical analysis. KS data collection. GJM and JZ contributed in creation of protocols described in the manuscript. GJM contributed in manuscript editing and figure design. All authors reviewed the manuscript.

Corresponding author

Correspondence to Gareth J. Morgan.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mejia, E., McLennan, D., Zablah, J. et al. Establishing Carotid Seldinger as Routine Access in Infants; Planning, Performance, and Follow-Up Protocols. Pediatr Cardiol 44, 1815–1820 (2023). https://doi.org/10.1007/s00246-023-03267-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-023-03267-x

Keywords

Search

Navigation