■小儿心脏导管插入术中的腋下动脉通路(AAA)被低估。
■我们回顾性回顾了在2019年1月至2023年2月期间接受经腋窝动脉插管的先天性心脏病(CHDs)儿童。我们将超声引导的穿刺对准直径≥2mm的腋窝动脉的近端三分之二,以插入7cm/4Fr短插管器。我们服用了动脉内维拉帕米(1.25mg)和肝素(100UI/kg)。我们在动脉痉挛中每次手术浸润2%利多卡因(10毫克),长鞘使用(≥5Fr),<3kg患者的手术时间≥60分钟。
■我们确定了30名患者(66.7%为男性),中位年龄为1.1个月(IQR,0.3-5.4),体重中位数为3.1公斤(IQR,2.7-3.7)。5/30患者在中位3.9个月后进行了6次重做干预(IQR,1.7-5.1)。总的来说,27/36程序是介入性的,包括6例主动脉瓣置换术,6球囊血管成形术,和15个支架手术。正中动脉腋窝血管造影直径为2.6mm(IQR,2.4-3).在23/36(63.9%)程序中进入右侧,在25/36(69.4%)程序中使用21G/2.5cm斜角针获得。引入解痉挛药物后未发生血液动力学变化。中位透视时间为26.1分钟(IQR,19.2-34.8)。有两个自我解决的动脉夹层,1例亚闭塞性动脉血栓形成(依诺肝素治疗6周),1例闭塞性动脉血栓形成(阿替普酶溶栓和6周依诺肝素治疗)。中位随访时间为11.7个月(IQR,8-17.5).四名患有复杂单室心脏的患者死于非手术原因,中位时间为40天(IQR,31-161)术后。
■AAA的系统方法是成功的关键,并释放了经腋窝儿科心脏病学干预的许多潜力。
UNASSIGNED: Axillary arterial access (AAA) in pediatric heart catheterizations is undervalued.
UNASSIGNED: We retrospectively reviewed children with congenital heart diseases (CHDs) who received trans-axillary arterial catheterizations between January 2019 and February 2023. We aimed ultrasound-guided punctures in the proximal two-thirds of axillary arteries with diameters ≥2 mm to insert 7 cm/4 Fr short introducers. We administrated intra-arterial verapamil (1.25 mg) and heparin (100 UI/kg). We infiltrated per-operatively 2% lignocaine (10 mg) for arterial spasms, long sheaths use (≥5 Fr), and ≥60 min procedures in <3 kg patients.
UNASSIGNED: We identified 30 patients (66.7% males) with a median age of 1.1 months (IQR, 0.3-5.4), and a median weight of 3.1 kg (IQR, 2.7-3.7). 5/30 patients had six redo interventions after a median of 3.9 months (IQR, 1.7-5.1). Overall, 27/36 procedures were interventional, including 6 aortic valvuloplasties, 6 balloon angioplasties, and 15 stenting procedures. The median arterial axillary angiographic diameter was 2.6 mm (IQR, 2.4-3). Access was right-sided in 23/36 (63.9%) procedures and obtained using 21G/2.5 cm bevel needles in 25/36 (69.4%) procedures. No hemodynamical change occurred after introducing spasmolytic drugs. The median fluoroscopy time was 26.1 min (IQR, 19.2-34.8). There were two self-resolving arterial dissections, one sub-occlusive arterial thrombosis (resolved with 6 weeks of enoxaparin), and one occlusive arterial thrombosis (resolved with alteplase thrombolysis and 6 weeks of enoxaparin). Median follow-up was 11.7 months (IQR, 8-17.5). Four patients with complex univentricular hearts died from non-procedural causes at a median of 40 days (IQR, 31-161) postoperative.
UNASSIGNED: Systematic approach for AAA is the key to success and unlocks the many potentials of trans-axillary pediatric cardiology interventions.