1. Percutaneous Patent Ductus Arteriosus Stenting Using the Carotid or Axillary Artery: A Multicenter Study from the Congenital Catheterization Research Collaborative
Holly Bauser-Heaton1, Athar M. Qureshi2, Bryan H. Goldstein3, Andrew C. Glatz4, George T. Nicholson5, Jeffrey Meadows6, John Depaolo4,
Courtney E. McCracken7, Emad Mossad2, Elizabeth Wilson8 , Christopher J. Petit1
1Children’s Healthcare of Atlanta, Emory University School of Medicine, 2Texas Children’s Hospital, 3Cincinnati Children’s Hospital Medical Center, 4Children’s Hospital of Philadelphia, 5 Vanderbilt Children’s Hospital, 6University of California at San Francisco, 7Emory University School of Medicine
Results
Background
Carotid artery (CA) and axillary artery (AA) access have been used increasingly for stenting of the patent ductus arteriosus (PDA), although reports are limited. The Congenital Catheterization Research Collaborative reviewed multicenter data from infants who underwent PDA stenting via the CA or AA approach.
Table 3: Complications
Table 2: Comparison of Patient and Clinical Characteristics by Access Site
Total of 49 infants underwent successful PDA stenting from the CA (87.5%) or AA (12.5%)
The PDA was the sole pulmonary blood flow source in 61.2% of pts.
Among the cohort ductal tortuosity was noted: 10 (20.4%) had mild (tortuosity index I), 17 (34.7%) had moderate (type II), and 22 (44.9%) had severe (type III).
In 17 pts, the flip technique was used, with decreased procedure times for severe tortuosity pts (p=0.024).
Complications from CA or AA access were minor in all but 4 patients with occlusion which resolved with anticoagulation
Approach from CA or AA access were more likely to have sole source pulmonary blood flow when compared to FA approach (61.2% vs 32.7%)
Methods
Retrospective review among 6 centers was performed from
Reviewed characteristics of the technique, the range of PDA morphology stented (tortuosity index 1, 2 or 3), and the use of the “flip technique”
The post ultrasound (US) imaging was reviewed for vascular findings for all carotid access pts as well as available axillary access pts.
Femoral artery (FA) and carotid/axillary approaches were compared to determine differences in ductal tortuosity and sole source pulmonary blood flow
Figure 2: Tortuosity indices I
III II
Conclusions
Use of CA and AA access for PDA stenting was found to be feasible, even in highly tortuous PDAs. Attention should be paid to the CA and AA following PDA stenting given the rate of findings post-intervention. Approaches such as flipping the pt with can lead to shorter procedure times due to improved positioning for operator movement. The CA or AA approach may have advantages over FA for certain PDA morphologies.
Table 1: Procedure time for carotid sheath vs total procedure
Figure 1: Procedure time by technique
Disclosures
This study was supported in part by a generous donation on behalf of the Kennedy Hammill family.
*Procedure time = first sheath in to last sheath out
Carotid sheath = carotid sheath in to carotid sheath out
** Median (25th – 75th) [Min, Max]
“Flip” position