Percutaneous axillary artery approach for ductal stenting in critical right ventricular outflow tract lesions in the neonatal period

Colm R. Breatnach, Varun Aggarwal, Khalid Al-Alawi, Colin J. McMahon, Orla Franklin, Terence Prendiville, Paul Oslizlok, Kevin Walsh, Athar M. Qureshi, Damien Kenny

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objectives: We aimed to assess the experience using a percutaneous axillary artery approach for insertion of arterial ductal stents in patients with critical right ventricular outflow tract lesions at two tertiary pediatric cardiology centers. Background: Patent ductus arteriosus stenting is an accepted palliative alternative to BT shunts for neonates with critical right heart lesions. Access to tortuous ductus' may be challenging via the femoral artery, whereas the carotid artery presents a low risk of stroke. Recently, the axillary artery has been utilized for access in these patients. Methods: We performed a retrospective review of neonates who underwent stent placement or angioplasty using percutaneous axillary artery approach at two tertiary care centers from October 2016 to November 2018. Medical records were reviewed to ascertain demographic, clinical, and outcome data. Results: Axillary artery access was performed in 20 patients (16 primary ductal stents and 4 re-interventions) at a median (IQR) procedural weight of 3.4 (3–3.9) kg. Median (IQR) procedural time was 110 (75–150) min. The median (IQR) ICU stay and intubation times were 14 (0–94) hr and 5 (0–40) hr, respectively. There were three access-related vascular complications which were managed conservatively with no long-term effects. Two patients subsequently died due to non-procedure related causes. Conclusions: Ductal stenting via a percutaneous axillary artery approach is a viable option in neonates with critical right ventricular outflow tract lesions. This approach provides an additional access site for PDA stenting which may be utilized in patients with vertical duct morphology.

Original languageEnglish (US)
Pages (from-to)1329-1335
Number of pages7
JournalCatheterization and Cardiovascular Interventions
Volume93
Issue number7
DOIs
StatePublished - Jun 1 2019
Externally publishedYes

Keywords

  • complications, pediatric catheterization/intervention
  • congenital heart disease, pediatric
  • stenting technique
  • structural heart disease intervention

PubMed: MeSH publication types

  • Journal Article
  • Multicenter Study

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