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Frequency and risk factors of acute and permanent femoral arterial occlusion in neonates with congenital heart disease who undergo ultrasound˗guided femoral arterial access

Background: In neonates, securing femoral arterial access is challenging
and time consuming even in experienced hands. Data on frequency and risk
factors of ALAP and PFAO are scarce in neonates with CHD. We
investigated frequency and risk factors of acute loss of the arterial
pulse (ALAP) and permanent femoral arterial occlusion (PFAO) in neonates
with congenital heart disease (CHD) underwent ultrasound˗guided femoral
arterial access (US˗GFAA). Methods: We divided the patients into groups
according to the presence of ALAP and PFAO. We obtained data related to
patient characteristics and access variables of US˗GFAA from our
database of pediatric cardiac catheterization between August 2017 and
May 2021. We used an echocardiography˗S6, 12˗MHz linear probe, 21˗gauge
needle, and a 0.018”guidewire for arterial access. A 4˗French sheath
(7cm) was placed in all patients. Results: US˗GFAA was obtained in
323(98.8%) of the 327 neonates. We identified ALAP in 130(40.2%)
patients and PFAO in 19(5.9%) patients. Median weight was 3.05(IQR:
2.80˗3.40) kg, first attempt success rate was 88.2% and median access
time was 46 sec (IQR: 23˗94). Logistic regression analysis identified
coarctation of the aorta (Odds ratio: 2.46; 95% CI: 1.30˗4.66; P=0.006)
as independent risk factor for ALAP, but did not identify any
independent risk factors for PFAO. Conclusion: This study showed that
coarctation of the aorta is an independent risk factor for ALAP in
neonates with CHD underwent US˗GFAA and placed a 4˗French sheath.
Although most cases of ALAP resolve in the early period, the frequency
of PFOA remains high despite effective treatment.