The objectives of this study were to construct femoral artery (FA) and femoral vein (FV) nomograms in children aged 0–4 years and to construct probability curves for the occurrence of arterial access complications based on the size of the FA. The FV and FA are commonly accessed during cardiac catheterizations in children with congenital heart diseases (CHD). However, nomograms for vessel dimensions based on child’s age or size are not available. This knowledge may be helpful for interventional planning. A prospective study was performed on 400 children (age 0–4 years) with CHD undergoing cardiac catheterizations over a 3-year period. Ultrasound evaluation of the right and left FA and FV was performed under anesthesia prior to vascular access. Regression modeling was applied to derive nomograms based on quantile polynomial regression, which yielded good fit to the data judged by R-squared. GAMLSS transformation method was used to formulate smoothed percentiles. A separate prospective evaluation of FA to determine the size below which loss of pulse (LOP) are likely to occur was performed. Nomograms for FA and FV diameter and cross-sectional area against age and body surface area and probability curves for FA LOP were constructed. It is now possible to examine ultrasound-based normal sizes of femoral vein and artery in children 0–4 years of age. Femoral vessel nomograms and LOP probability curves may help with interventional planning. Future studies with larger sample size, including children of other ages may be useful.

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.

To compare image quality, radiation and contrast doses required to obtain 3D‐Digital subtraction rotational angiography (3D‐DSRA) with 3D‐Digital rotational angiography (3D‐DRA) in infants (children ≤ 2 years of age) and adults with congenital heart diseases (ACHD).

Objectives The aim of this study was to evaluate the effectiveness of UltraBLOX™ radiation attenuating hand cream during lengthy cardiac catheterization procedures in children. Background The hands of interventional cardiologists receive high doses of radiation due to their proximity to the X‐ray beam. Radiation attenuating gloves have about a 26% attenuation rate, but reduce dexterity and tactile sensation. The UltraBLOX™ cream is a new FDA‐approved X‐ray attenuating cream that can be applied to the operator's hands for radio‐protection. Methods Two nanoDot™ dosimeters were secured side by side on the dorsum of the operator's ( n = 2) left hand close to the wrist. One dosimeter and the rest of the hand were covered with 0.2 mm layer of the cream. The other dosimeter was unshielded. Procedures were performed using 110 kVp fluoroscopy at 15 pulses/sec. The measurements were categorized into four groups dependent on the duration of the procedure. The patients in all four groups were well matched for age and size. Results Procedural and cumulative hand radiation doses were higher with longer procedural duration. The overall % attenuation by the cream was 39.7% (28.6–51.5) and was unaffected by the length of the procedure (median: 40.9% at 30 min and 41.4% at 180 min; P = 0.66) or the dose of radiation. The kappa statistic for interobserver agreement for good tactile sensitivity was 0.82. Conclusions UltraBLOX™ cream provides a new option for radio‐protection for the hands of interventional cardiologists without impairing tactile sensitivity. There was no decrease in attenuation up to 180 min. © 2016 Wiley Periodicals, Inc.

Objectives: 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. VC 2016 Wiley Periodicals, Inc.

OBJECTIVES: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.

Objectives: The aim of this study was to describe and differentiate the morphology of patent ductus arteriosus (PDA) seen in children born prematurely from other PDA types.Background: PDAs are currently classified as types A‐E using the Krichenko's classification. Children born prematurely with a PDA morphology that did not fit this classification were described as Type F PDA.Methods: A review of 100 consecutive children who underwent transcatheter device closure of PDA was performed. The diameter and length (L) of the PDA and the device diameter (D) were indexed to the descending aorta (DA) diameter.Results: Comparison of 26 Type F PDAs was performed against, 29 Type A, 7 Type C and 32 Type E PDAs. Children with Type F PDAs (median 27.5 weeks gestation) were younger during the device occlusion compared with types A, C, and E (median age: 6 vs. 32, 11, and 42 months; P = 0.002). Type F PDAs were longer and larger, requiring a relatively large device for occlusion than types A, C, and E (Mean L/DA: 1.88 vs. 0.9, 1.21, and 0.89, P ≤ 0.01 and Mean D/DA: 1.04 vs. 0.46, 0.87, and 0.34, P ≤0.01). The Amplatzer vascular plug‐II (AVP‐II) was preferred for occlusion of Type F PDAs (85%; P <0.001).Conclusions: Children born prematurely have relatively larger and longer PDAs. These “fetal type PDAs” are best classified separately. We propose to classify them as Type F PDAs to add to types A‐E currently in use. The AVP‐II was effective in occluding Type F PDAs. © 2015 Wiley Periodicals, Inc.

Acute loss of arterial pulse (LOP) is a known complication in children following arterial access for cardiac catheterization. In the modern era of using ultrasound guided femoral arterial access (UGFAA),the incidence of LOP in children has not been described. The incidence of LOP requiring treatment

A 53-year-old African-American female with end-stage renal disease presented with 3 months history of right breast swelling. The patient had a right internal jugular tunneled catheter for dialysis access. Physical examination was significant for right breast swelling, peau d'orange appearance, and mild tenderness on palpation. Mammogram was normal. A CT scan of the chest with contrast demonstrated chest wall edema and prominent superficial collateral veins suggesting central vein obstruction. Right upper extremity venogram revealed right innominate vein occlusion up to its junction with the subclavian vein. Angioplasty of occluded segment was attempted and was unsuccessful, but right breast swelling significantly improved following the procedure. Pathogenesis, clinical manifestations and management of central vein stenosis is discussed.