Femoral Artery Thrombosis After Pediatric Cardiac Catheterization

Abstract

Femoral artery thrombosis (FAT) is an adverse event post-catheterization. We decided to study the incidence and risk factors of FAT before and after initiation of a pulse loss monitoring program. All cardiac catheterization cases performed using femoral arterial vascular access were retrospectively reviewed. The study period was divided into two eras: before (era 1), and after the initiation of the protocol (era 2). The primary outcome was FAT requiring therapy. Univariable and multivariable logistic regression models were used to identify factors associated with FAT. Receiver operating characteristic curve were generated to predict FAT. Our cohort consisted of 2,388 cases including 467 (19.6%) infants weighing < 10 kg. The overall incidence of FAT was 1.7% (n = 41). The incidence of FAT was 3.5 times higher in era 2 (p < 0.001). Multivariable model showed that era, weight, sheath exchange, and coarctation intervention were significantly associated with FAT. Infants younger than 7.7 months and less than 6.7 kg were found to be at highest risk for FAT. Our study shows that the incidence of FAT may be underestimated without a monitoring program. Small infants and coarctation interventions requiring larger sheaths or sheath exchanges are at highest risk for FAT.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

Abbreviations

FAT:

Femoral artery thrombosis

References

  1. 1.

    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 82:454–462

    Article  Google Scholar 

  2. 2.

    Andraska EA, Jackson T, Chen H, Gallagher KA, Eliason JL, Coleman DM (2017) Natural history of Iatrogenic pediatric femoral artery injury. Ann Vasc Surg 42:205–213

    Article  Google Scholar 

  3. 3.

    Rizzi M, Kroiss S, Kretschmar O, Forster I, Brotschi B, Albisetti M (2016) Long-term outcome of catheter-related arterial thrombosis in infants with congenital heart disease. J Pediatr 170(181–7):e1

    Google Scholar 

  4. 4.

    Mehta R, Lee KJ, Chaturvedi R, Benson L (2008) Complications of pediatric cardiac catheterization: a review in the current era. Catheter Cardiovasc Interv 72:278–285

    Article  Google Scholar 

  5. 5.

    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 75:389–400

    PubMed  Google Scholar 

  6. 6.

    Kim J, Sun Z, Benrashid E, Southerland KW, Lawson JH, Fleming GA, Hill KD, Tracy ET (2017) The impact of femoral arterial thrombosis in paediatric cardiac catheterisation: a national study. Cardiol Young 27:912–917

    Article  Google Scholar 

  7. 7.

    Kulkarni S, Naidu R (2006) Vascular ultrasound imaging to study immediate postcatheterization vascular complications in children. Catheter Cardiovasc Interv 68:450–455

    Article  Google Scholar 

  8. 8.

    Knirsch W, Kellenberger C, Dittrich S, Ewert P, Lewin M, Motz R, Nürnberg J, Kretschmar O (2013) Femoral arterial thrombosis after cardiac catheterization in infancy: impact of Doppler ultrasound for diagnosis. Pediatr Cardiol 34:530–535

    Article  Google Scholar 

  9. 9.

    Kamyszek RW, Leraas HJ, Nag UP, Olivere LA, Nash AL, Kemeny HR, Kim J, Hill KD, Fleming GA, Jooste EH, Otto J, Tracy ET (2019) Routine postprocedure ultrasound increases rate of detection of femoral arterial thrombosis in infants after cardiac catheterization. Catheter Cardiovasc Interv 93:652–659

    Article  Google Scholar 

  10. 10.

    Glatz AC, Keashen R, Chang J, Balsama LA, Dori Y, Gillespie MJ, Giglia TM, Raffini L, Rome JJ (2015) Outcomes using a clinical practice pathway for the management of pulse loss following pediatric cardiac catheterization. Catheter Cardiovasc Interv 85:111–117

    Article  Google Scholar 

  11. 11.

    Lang TA, Secic M (2006) Predicting values from one or more variables. How to report statistics in medicine, 2nd edn. American College of Physicians, Philadelphia, PA, pp 85–105

    Google Scholar 

  12. 12.

    Ding L, Pockett C, Moore J, El-Said H (2016) Long sheath use in femoral artery catheterizations in infants <15 kg is associated with a higher thrombosis rate: proposed protocol for detection and management. Catheter Cardiovasc Interv 88:1108–1112

    Article  Google Scholar 

  13. 13.

    Alexander J, Yohannan T, Abutineh I, Agrawal V, Lloyd H, Zurakowski D, Waller BR 3rd, Sathanandam S (2016) 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. Catheter Cardiovasc Interv 88:1098–1107

    Article  Google Scholar 

Download references

Funding

This study was not funded.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Neha Bansal.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

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

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Bansal, N., Misra, A., Forbes, T.J. et al. Femoral Artery Thrombosis After Pediatric Cardiac Catheterization. Pediatr Cardiol (2021). https://doi.org/10.1007/s00246-020-02537-2

Download citation

Keywords

  • Peripheral-access-femoral
  • Peripheral-complication-access site
  • Peripheral-complication-vessel occlusion