Cardiac Cath-Related Arterial Thrombosis in Children
Objective Arterial thrombosis is one of the most reported complications of cardiac catheterisation (CC) in children. The aim of the study was to evaluate the incidence and predictors of arterial thrombosis in children with cardiac diseases (CDs).
Methods During 12 consecutive months, all children aged 0–19 years undergoing CC of the femoral arteries were included in this observational study. After CC, clinical evaluation of impaired limb perfusion was performed according to local guidelines. Doppler ultrasonography was performed when decreased limb perfusion was suspected.
Results 123 children (30% aged <12 months, 70% aged >12 months) underwent CC. Arterial thrombosis occurred in 14 of the 123 children (11.4%). Twelve cases (12/14=86%) of arterial thrombosis occurred in infants aged <12 months and 2 (2/14=14%) in older children. Overall younger age (p<0.01, OR (95% CI) 0.49 (0.28 to 0.86)) and low body weight (p<0.004, OR (95% CI) 0.78 (0.65 to 0.92)) were significantly associated with an increased risk of arterial thrombosis. Cyanotic CD (p=0.07, OR (95% CI) 2.87 (0.90 to 9.15)) showed a trend towards increased thrombotic risk.
Conclusions Arterial thrombosis is a common complication of CC in infants. Diagnosis of CC-related arterial thrombosis remains a challenge. Well-defined clinical monitoring protocols may be valuable methods for timely detection and treatment of arterial thrombosis.
Cardiac catheterisation (CC) has become a relevant procedure for the diagnosis and for the treatment of several congenital or acquired cardiac diseases (CDs) in children. Avoiding the need for cardiac surgery with long recovery time, congenital atrial or ventricular septal defects can be closed nowadays with devices that are delivered through the cardiac catheter. Similarly, congenital obstructed blood vessels and valves can be opened with balloon or stent technology or even replaced by transcatheter valve placement such as the Melody pulmonary valve.
Although increasing evidence suggests a substantial decrease in procedural-related complications during the past years, arterial thrombosis remains one of the most reported complications of CC in children. Short-term complications of arterial thrombosis of the femoral arteries may cause skin necrosis and threaten limb viability. Despite the lack of long-term outcome data, late complications including leg length difference and claudication have been postulated. It is quite evident that thrombotic occlusion of femoral arteries in children with complex CD may complicate future CCs. Thus, each single CC-related arterial thrombotic complication in these children demands special attention.
The reported incidence of arterial thrombosis after CC varies between 1% and 33%. This wide difference reflects different study designs and inclusion criteria and the fact that no guidelines for the diagnosis of these thrombotic complications are available, so far. The aim of this observational study was to evaluate the incidence of CC-related arterial thrombosis, to define predictors of these thrombotic complications in children with CD and to provide a broad, critical comparison of the literature.
Abstract and Introduction
Abstract
Objective Arterial thrombosis is one of the most reported complications of cardiac catheterisation (CC) in children. The aim of the study was to evaluate the incidence and predictors of arterial thrombosis in children with cardiac diseases (CDs).
Methods During 12 consecutive months, all children aged 0–19 years undergoing CC of the femoral arteries were included in this observational study. After CC, clinical evaluation of impaired limb perfusion was performed according to local guidelines. Doppler ultrasonography was performed when decreased limb perfusion was suspected.
Results 123 children (30% aged <12 months, 70% aged >12 months) underwent CC. Arterial thrombosis occurred in 14 of the 123 children (11.4%). Twelve cases (12/14=86%) of arterial thrombosis occurred in infants aged <12 months and 2 (2/14=14%) in older children. Overall younger age (p<0.01, OR (95% CI) 0.49 (0.28 to 0.86)) and low body weight (p<0.004, OR (95% CI) 0.78 (0.65 to 0.92)) were significantly associated with an increased risk of arterial thrombosis. Cyanotic CD (p=0.07, OR (95% CI) 2.87 (0.90 to 9.15)) showed a trend towards increased thrombotic risk.
Conclusions Arterial thrombosis is a common complication of CC in infants. Diagnosis of CC-related arterial thrombosis remains a challenge. Well-defined clinical monitoring protocols may be valuable methods for timely detection and treatment of arterial thrombosis.
Introduction
Cardiac catheterisation (CC) has become a relevant procedure for the diagnosis and for the treatment of several congenital or acquired cardiac diseases (CDs) in children. Avoiding the need for cardiac surgery with long recovery time, congenital atrial or ventricular septal defects can be closed nowadays with devices that are delivered through the cardiac catheter. Similarly, congenital obstructed blood vessels and valves can be opened with balloon or stent technology or even replaced by transcatheter valve placement such as the Melody pulmonary valve.
Although increasing evidence suggests a substantial decrease in procedural-related complications during the past years, arterial thrombosis remains one of the most reported complications of CC in children. Short-term complications of arterial thrombosis of the femoral arteries may cause skin necrosis and threaten limb viability. Despite the lack of long-term outcome data, late complications including leg length difference and claudication have been postulated. It is quite evident that thrombotic occlusion of femoral arteries in children with complex CD may complicate future CCs. Thus, each single CC-related arterial thrombotic complication in these children demands special attention.
The reported incidence of arterial thrombosis after CC varies between 1% and 33%. This wide difference reflects different study designs and inclusion criteria and the fact that no guidelines for the diagnosis of these thrombotic complications are available, so far. The aim of this observational study was to evaluate the incidence of CC-related arterial thrombosis, to define predictors of these thrombotic complications in children with CD and to provide a broad, critical comparison of the literature.