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Percutaneous axillary artery approach for ductal stenting in critical right ventricular outflow tract lesions in the neonatal period
Author(s) -
Breatnach Colm R.,
Aggarwal Varun,
AlAlawi Khalid,
McMahon Colin J.,
Franklin Orla,
Prendiville Terence,
Oslizlok Paul,
Walsh Kevin,
Qureshi Athar M.,
Kenny Damien
Publication year - 2019
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28302
Subject(s) - medicine , ductus arteriosus , axillary artery , percutaneous , ventricular outflow tract , surgery , angioplasty , stent , great arteries , radiology , cardiology , heart disease
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.