The successful use of alternative routes of vascular access for performing pediatric interventional cardiac catheterization.

OBJECTIVE: The objective of this study is to examine the safety/efficacy of alternative routes of vascular access (ARVA) for successful performance of interventions.

BACKGROUND: Complex interventional catheterizations may be required in children with limited vascular access, vascular constraints relative to size, and hemodynamic instability. Our approach has been to utilize ARVA in selected cases.

METHODS: ARVA pertains to any vessel excluding femoral, jugular/subclavian veins, or umbilical access. A retrospective review performed on patients with an intervention utilizing ARVA between August 1995 and January 2004 was performed. Patients were divided by clinical status: critically ill/emergent (A), elective cases (B). Procedural success was based on previously published criteria.

RESULTS: Sixty-four interventions were performed in 50 patients using 54 ARVA. ARVA utilized: radial (1), axillary (2), brachial (2), carotid arteries (25); brachial (2) hepatic (9) veins; and open chest/direct cardiac puncture (13). ARVA provided successful access to target lesions. Interventions included stents (30), valvuloplasty (16), angioplasty (14), and one each of vascular occlusion, septal occlusion, accessory pathway ablation, and septostomy. Group A patients were smaller (P < 0.0002) and younger (P < 0.004) than B. All open chest/direct cardiac and the majority (71%) of carotid arterial approaches were performed in group A. Fifty-six (88%) inteventions were successful with no difference between groups A (88%) and B (86%). There were two complications. Neither resulted in long-term sequelae.

CONCLUSIONS: ARVA may provide a strategic advantage that may be safely applied to a variety of interventions regardless of patient size or degree of illness. These techniques may further extend the scope of successful interventions in children.