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Amaya-Zúñiga WF, Mojica-Manrique V, Vergara-Escudero R, Amaya S. Transhepatic right heart ultrasound for central venous catheter tip location in patients with difficult acoustic windows. J Vasc Access 2024; 25:688-690. [PMID: 36113078 DOI: 10.1177/11297298221122116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Affiliation(s)
- William F Amaya-Zúñiga
- Department of Anesthesia and Perioperative Medicine, Cardiovascular and Transplant Anesthesiologist, Hospital Universitario Fundación Santa Fe de Bogotá, Clinical Professor Universidad de los Andes, Universidad El Bosque. Bogotá, Colombia
| | - Viviana Mojica-Manrique
- Department of Anesthesia and Perioperative Medicine, Anesthesiologist and Regional Anesthesia Specialist, Hospital Universitario Fundación Santa Fe de Bogotá. Bogotá, Colombia
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Flores S, Su E, Moher JM, Adler AC, Riley AF. Point-of-Care-Ultrasound in Pediatrics: A Review and Update. Semin Ultrasound CT MR 2024; 45:3-10. [PMID: 38056790 DOI: 10.1053/j.sult.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Point-of-Care-Ultrasound (POCUS) has encountered a tremendous expansion in patient care. POCUS has taken a central role during invasive procedures. POCUS has expanded to most subspecialties from adult to pediatric and neonatal health care. POCUS in pediatrics has also become part of specific critical situations such as myocardial function assessment during cardiac arrest, extracorporeal membrane oxygenation deployment and neurological evaluation. In this review we will go over the most important historical aspects of POCUS. We will also review important aspects of POCUS in the intensive care unit, cardiologist evaluation and in the emergency department among others.
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Affiliation(s)
- Saul Flores
- Department of Pediatrics, Division of Critical Care and Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
| | - Erik Su
- Department of Pediatrics, Division of Critical Care, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Justin M Moher
- Department of Pediatrics, Division of Emergency Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Adam C Adler
- Department of Anesthesiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Alan F Riley
- Department of Pediatrics, Division of Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
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Koneti N, Dhulipudi B, Bakhru S, Singh J. Transhepatic device closure of atrial septal defect in children associated with interrupted inferior vena cava. Ann Pediatr Cardiol 2022; 15:160-163. [PMID: 36246740 PMCID: PMC9564410 DOI: 10.4103/apc.apc_228_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/19/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022] Open
Abstract
Percutaneous transcatheter closure of fossa ovalis atrial septal defect (FOASD) is an established procedure. When femoral venous approach is unfeasible due to interrupted inferior vena cava (IVC) or occluded femoral veins, other interventional methods through transjugular, transhepatic approach, or surgical closure can be performed. We report two cases of transhepatic device closure of FOASD associated with IVC interruption successfully performed without any complications.
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Yang M, Slack M, Waksman R, Ben-Dor I. Transhepatic access: Alternative approach for right heart catheterization and pulmonary angiography. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 40S:159-161. [DOI: 10.1016/j.carrev.2022.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 11/16/2022]
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Suryanarayana PG, Ayers M, Trerotola SO, Nazarian S. Direct hepatic vein puncture and transseptal access for atrial flutter and fibrillation ablation in a patient with prior ligation of the inferior vena cava. HeartRhythm Case Rep 2020; 6:382-385. [PMID: 32695582 PMCID: PMC7360982 DOI: 10.1016/j.hrcr.2020.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Prakash Goutham Suryanarayana
- Cardiac Electrophysiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael Ayers
- Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott O Trerotola
- Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Saman Nazarian
- Cardiac Electrophysiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Soto R, Jimenez A, Garcia F, Saenz LC, Rodriguez DA. Percutaneous transhepatic venous access for atrial tachyarrhythmia ablation in patients with single ventricle and interrupted inferior vena cava. HeartRhythm Case Rep 2018; 5:31-35. [PMID: 30693202 PMCID: PMC6342726 DOI: 10.1016/j.hrcr.2018.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Richard Soto
- Division of Cardiology, Department of Cardiac Electrophysiology, National Cardiovascular Institute INCOR, Lima, Peru
| | - Alejandro Jimenez
- Division of Cardiology, Department of Cardiac Electrophysiology, University of Maryland Medical System, Baltimore, Maryland
| | - Fermin Garcia
- Division of Cardiology, Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Luis C Saenz
- International Arrhythmia Center, Cardiology Institute, Fundación Cardioinfantil, University of La Sabana, Bogota, Colombia
| | - Diego A Rodriguez
- International Arrhythmia Center, Cardiology Institute, Fundación Cardioinfantil, University of La Sabana, Bogota, Colombia
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Cha MJ, Uhm JS, Kim TH, Choi EK, Joung B, Pak HN, Oh S, Lee MH. Two Cases of Transhepatic Implantation of Cardiac Implantable Electronic Device: All Roads lead to Rome. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2017. [DOI: 10.18501/arrhythmia.2017.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Traditional Long-Term Central Venous Catheters Versus Transhepatic Venous Catheters in Infants and Young Children. Pediatr Crit Care Med 2017; 18:944-948. [PMID: 28746169 DOI: 10.1097/pcc.0000000000001276] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Children with congenital heart disease may require long-term central venous access for intensive care management; however, central venous access must also be preserved for future surgical and catheterization procedures. Transhepatic venous catheters may be an useful alternative. The objective of this study was to compare transhepatic venous catheters with traditional central venous catheters regarding complication rate and duration of catheter service. DESIGN Retrospective review of 12 congenital heart disease patients from September 2013 to July 2015 who underwent placement of one or more transhepatic venous catheters. SETTING Single freestanding pediatric hospital located in the central United States. PATIENTS Pediatric patients with congenital heart disease who underwent placement of transhepatic venous catheter. INTERVENTIONS Cohort's central venous catheter complication rates and duration of catheter service were compared with transhepatic venous catheter data. MEASUREMENTS AND MAIN RESULTS Twelve patients had a total of 19 transhepatic venous lines. Transhepatic venous lines had a significantly longer duration of service than central venous lines (p = 0.001). No difference between the two groups was found in the number of documented thrombi, thrombolytic burden, or catheter sites requiring wound care consultation. A higher frequency of infection in transhepatic venous lines versus central venous lines was found, isolated to four transhepatic venous lines that had a total of nine infections. All but one was successfully managed without catheter removal. The difference in the proportion of infections to catheters in transhepatic venous lines versus central venous lines was significant (p = 0.0001), but no difference in the rate of infection-related catheter removal was found. CONCLUSIONS Without compromising future central venous access sites, transhepatic venous lines had superior duration of service without increased thrombosis, thrombolytic use, or insertion site complications relative to central venous lines. Transhepatic venous catheters had a higher infection rate, and further investigation into the etiology is warranted.
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Abstract
OBJECTIVES Patients with congenital heart disease may have limited venous access routes as a result of multiple central venous catheters, surgical interventions, and catheterization procedures. Unconventional venous access includes transhepatic central venous catheter. We evaluated transhepatic central venous catheter placed in patients with congenital heart disease and risk factors associated with complications and outcomes. DESIGN Demographic, procedural, and complication data were retrospectively collected on all patients who underwent transhepatic central venous catheter placement at our center over the past 10 years. SETTING This study was completed in a tertiary congenital heart center. PATIENTS A total of 92 transhepatic central venous catheters were placed in 54 patients (63% male patients). The median age and weight of the patient population was 5.7 months and 5.5 kg, respectively. INTERVENTIONS Placement of a transhepatic central venous catheter. MEASUREMENTS AND MAIN RESULTS Successful catheter placement occurred in 96% of cases with median procedure time of 54 minutes with a procedural complication rate of 14%. A total of 86 complications occurred in 54 catheters placed during 2,166 catheter-days (39.7 complications per 1,000 catheter-days). Individual complication rates per 1,000 catheter-days included catheter dysfunction (14.8), dislodgement (8.8), systemic infection (5.1), thrombosis (4.2), local infection (3.7), and bleeding (3.2). Two complications contributed to patient deaths. Factors associated with developing complications included polyurethane central venous catheters (p = 0.03) and catheter duration at least 21 days (p = 0.004). The overall mortality in this population was 50% with median length of hospitalization of 49 days (interquartile range, 33-97). CONCLUSIONS Transhepatic central venous catheters represent a viable option for patients with limited access. Polyurethane catheters and catheter duration at least 21 days are associated with increased transhepatic central venous catheter complications. Although complication rates are higher than more traditional forms of central venous catheters, the long duration of hospitalization and high mortality rates in this patient population attest to their risks for poor outcomes irrespective of venous access.
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Whiteside W, Christensen J, Zampi JD. Three-dimensional magnetic resonance imaging overlay to assist with percutaneous transhepatic access at the time of cardiac catheterization. Ann Pediatr Cardiol 2015; 8:150-2. [PMID: 26085770 PMCID: PMC4453187 DOI: 10.4103/0974-2069.154146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Multimodality image overlay is increasingly used for complex interventional procedures in the cardiac catheterization lab. We report a case in which three-dimensional magnetic resonance imaging (3D MRI) overlay onto live fluoroscopic imaging was utilized to safely obtain transhepatic access in a 12-year-old patient with prune belly syndrome, complex and distorted abdominal anatomy, and a vascular mass within the liver.
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Affiliation(s)
- Wendy Whiteside
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Jason Christensen
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, United States
| | - Jeffrey D Zampi
- Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Michigan, United States
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Qureshi AM, Prieto LR, Bradley‐Skelton S, Latson LA. Complications related to transhepatic venous access in the catheterization laboratory—A single center 12‐year experience of 124 procedures. Catheter Cardiovasc Interv 2014; 84:94-100. [DOI: 10.1002/ccd.25278] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 09/26/2013] [Accepted: 10/23/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Athar M. Qureshi
- Center of Pediatric and Congenital Heart DiseaseThe Children's Hospital at The Cleveland ClinicCleveland Ohio
| | - Lourdes R. Prieto
- Center of Pediatric and Congenital Heart DiseaseThe Children's Hospital at The Cleveland ClinicCleveland Ohio
| | - Sharon Bradley‐Skelton
- Center of Pediatric and Congenital Heart DiseaseThe Children's Hospital at The Cleveland ClinicCleveland Ohio
| | - Larry A. Latson
- Center of Pediatric and Congenital Heart DiseaseThe Children's Hospital at The Cleveland ClinicCleveland Ohio
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Nguyen DT, Gupta R, Kay J, Fagan T, Lowery C, Collins KK, Sauer WH. Percutaneous transhepatic access for catheter ablation of cardiac arrhythmias. Europace 2013; 15:494-500. [PMID: 23385049 DOI: 10.1093/europace/eus315] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AIMS Femoral venous access may be limited in certain patients undergoing electrophysiology (EP) study and ablation. The purpose of this study is to review a series of patients undergoing percutaneous transhepatic access to allow for ablation of cardiac arrhythmias. METHODS AND RESULTS Six patients with a variety of cardiac arrhythmias and venous abnormalities underwent percutaneous transhepatic access. Under fluoroscopic and ultrasound guidance, a percutaneous needle was advanced into a hepatic vein and exchanged for a vascular sheath over a wire. Electrophysiology study and radiofrequency ablation was then performed. All tachycardias, including atrial tachycardia, atrial flutter, atrioventricular nodal tachycardia, and atrial fibrillation, were ablated. Procedural times ranged from 227 to 418 min. Fluoroscopy times ranged from 32 to 95 min. There were no complications. All six patients have been arrhythmia-free in follow-up (5-49 months, mean 23.1 months). CONCLUSION Percutaneous transhepatic access is safe and feasible in patients with limited venous access who are undergoing EP study and ablation for a range of cardiac arrhythmias.
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Affiliation(s)
- Duy Thai Nguyen
- Electrophysiology, University of Colorado, Anschutz Medical Campus, 12401 E. 17th Avenue, B-132, Aurora, CO 80045, USA.
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Singh SM, Neuzil P, Skoka J, Kriz R, Popelova J, Love BA, Mittnacht AJ, Reddy VY. Percutaneous Transhepatic Venous Access for Catheter Ablation Procedures in Patients With Interruption of the Inferior Vena Cava. Circ Arrhythm Electrophysiol 2011; 4:235-41. [DOI: 10.1161/circep.110.960856] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Sheldon M. Singh
- From the Cardiac Arrhythmia Service (S.M.S., V.Y.R.), Pediatric Cardiology (B.A.L.), and Anesthesiology (A.J.C.M.), Mount Sinai School of Medicine, New York, NY; and Cardiology Department, Homolka Hospital, Prague, Czech Republic (P.N., J.S., R.K., J.P., V.Y.R.)
| | - Petr Neuzil
- From the Cardiac Arrhythmia Service (S.M.S., V.Y.R.), Pediatric Cardiology (B.A.L.), and Anesthesiology (A.J.C.M.), Mount Sinai School of Medicine, New York, NY; and Cardiology Department, Homolka Hospital, Prague, Czech Republic (P.N., J.S., R.K., J.P., V.Y.R.)
| | - Jan Skoka
- From the Cardiac Arrhythmia Service (S.M.S., V.Y.R.), Pediatric Cardiology (B.A.L.), and Anesthesiology (A.J.C.M.), Mount Sinai School of Medicine, New York, NY; and Cardiology Department, Homolka Hospital, Prague, Czech Republic (P.N., J.S., R.K., J.P., V.Y.R.)
| | - Radko Kriz
- From the Cardiac Arrhythmia Service (S.M.S., V.Y.R.), Pediatric Cardiology (B.A.L.), and Anesthesiology (A.J.C.M.), Mount Sinai School of Medicine, New York, NY; and Cardiology Department, Homolka Hospital, Prague, Czech Republic (P.N., J.S., R.K., J.P., V.Y.R.)
| | - Jana Popelova
- From the Cardiac Arrhythmia Service (S.M.S., V.Y.R.), Pediatric Cardiology (B.A.L.), and Anesthesiology (A.J.C.M.), Mount Sinai School of Medicine, New York, NY; and Cardiology Department, Homolka Hospital, Prague, Czech Republic (P.N., J.S., R.K., J.P., V.Y.R.)
| | - Barry A. Love
- From the Cardiac Arrhythmia Service (S.M.S., V.Y.R.), Pediatric Cardiology (B.A.L.), and Anesthesiology (A.J.C.M.), Mount Sinai School of Medicine, New York, NY; and Cardiology Department, Homolka Hospital, Prague, Czech Republic (P.N., J.S., R.K., J.P., V.Y.R.)
| | - Alexander J.C. Mittnacht
- From the Cardiac Arrhythmia Service (S.M.S., V.Y.R.), Pediatric Cardiology (B.A.L.), and Anesthesiology (A.J.C.M.), Mount Sinai School of Medicine, New York, NY; and Cardiology Department, Homolka Hospital, Prague, Czech Republic (P.N., J.S., R.K., J.P., V.Y.R.)
| | - Vivek Y. Reddy
- From the Cardiac Arrhythmia Service (S.M.S., V.Y.R.), Pediatric Cardiology (B.A.L.), and Anesthesiology (A.J.C.M.), Mount Sinai School of Medicine, New York, NY; and Cardiology Department, Homolka Hospital, Prague, Czech Republic (P.N., J.S., R.K., J.P., V.Y.R.)
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Tzifa A, Ahmed I, Rosenthal E. Transhepatic portal vein access for balloon dilation of right upper pulmonary vein stenosis following infradiaphragmatic total anomalous pulmonary venous drainage repair. Catheter Cardiovasc Interv 2011; 78:698-701. [DOI: 10.1002/ccd.22906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 11/06/2010] [Accepted: 11/06/2010] [Indexed: 11/10/2022]
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Qureshi AM, Rhodes JF, Appachi E, Mumtaz MA, Duncan BW, Asnes J, Radavansky P, Latson LA. Transhepatic Broviac catheter placement for long-term central venous access in critically ill children with complex congenital heart disease. Pediatr Crit Care Med 2007; 8:248-53. [PMID: 17417124 DOI: 10.1097/01.pcc.0000265327.93745.89] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Critically ill children with cardiac disease often require prolonged central venous access. Thrombosis of systemic veins or the need to preserve vessels for future cardiac procedures limits sites for placement of central venous catheters in these patients. This study evaluates the use of Broviac placement via the transhepatic approach for this patient population. DESIGN A retrospective review. SETTING A tertiary care center. PATIENTS All children with complex congenital heart disease who underwent transhepatic Broviac placement between May 2000 and April 2004. INTERVENTIONS Transhepatic Broviac placement. MEASUREMENTS AND MAIN RESULTS Thirty-two children with a median age of 5 months (20 days-5.3 yrs) and a median weight of 4.2 kg (2.2-24.9 kg) underwent 40 transhepatic Broviac placements. There were three (8.8%) procedural-related complications. One patient suffered an intra-abdominal bleed requiring an urgent laparotomy and removal of the Broviac, one patient required transfusion because of a mild self-contained intra-abdominal bleed, and one patient developed temporary complete heart block. There was one catheter infection. Thrombus was noted by echocardiography on the tip of two Broviacs; however, no intracardiac vegetations or embolic events occurred. There was no mortality related to the procedure. Broviacs remained in place for a median of 36 days (1 day-6 months). Five Broviacs were dislodged inadvertently (two during cardiac massage and three resulting from patient manipulation). The remaining Broviacs were electively removed safely without coil embolization. At a median follow-up of 3.5 months (10 days-3 yrs), there have been no long-term complications related to the Broviacs. CONCLUSIONS Transhepatic Broviac catheters can be used safely in critically ill children with cardiac disease and remain indwelling for adequate periods of time. This modality of prolonged vascular access should be considered for children whose veins are occluded or need to be preserved for future procedures.
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Affiliation(s)
- Athar M Qureshi
- Department of Pediatric and Congenital Heart Disease, The Children's Hospital at the Cleveland Clinic, Cleveland, OH, USA.
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Ebeid MR. Transhepatic vascular access for diagnostic and interventional procedures: Techniques, outcome, and complications. Catheter Cardiovasc Interv 2006; 69:594-606. [PMID: 17152092 DOI: 10.1002/ccd.21012] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Early or multiple cardiac catheterizations may result in occlusion of the femoral veins prohibiting their use. The internal jugular or sub-clavian approach may be an appropriate alternative. However, these approaches may not be suitable in patients with surgical interruption of the superior vena cava. In other patients, they may not allow easy access to certain areas of the heart. The transhepatic approach is an important alternative route for performing cardiac catheterization and interventions. Depending on the planned procedure, it may be the preferred route to perform the cardiac catheterization even in the presence of patent femoral veins. The indications, technical details and potential complications of this approach are discussed.
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Affiliation(s)
- Makram R Ebeid
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS 39216, USA.
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Abstract
Pediatric interventional radiologists are ideally suited to provide vascular access services to children because of inherent safety advantages and higher success from using image-guided techniques. The performance of vascular access procedures has become routine at many adult interventional radiology practices, but this service is not as widely developed at pediatric institutions. Although interventional radiologists at some children's hospitals offer full-service vascular access, there is little or none at others. Developing and maintaining a pediatric vascular access service is a challenge. Interventionalists skilled in performing such procedures are limited at pediatric institutions, and institutional support from clerical staff, nursing staff, and technologists might not be sufficiently available to fulfill the needs of such a service. There must also be a strong commitment by all members of the team to support such a demanding service. There is a slippery slope of expected services that becomes steeper and steeper as the vascular access service grows. This review is intended primarily as general education for pediatric radiologists learning vascular access techniques. Additionally, the pediatric or adult interventional radiologist seeking to expand services might find helpful tips. The article also provides education for the diagnostic radiologist who routinely interprets radiographs containing vascular access devices.
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Affiliation(s)
- James S Donaldson
- Department of Medical Imaging, Children's Memorial Hospital, Northwestern University, Feinberg School of Medicine, 2300 Children's Plaza, No. 9, Chicago, IL 60614, USA.
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Abstract
Vascular access is needed to realize the potential of therapeutic cardiac catheterization and may consume up to 25% of the entire procedure time. Repeat interventions and multiple cardiac surgeries may result in incremental loss of access sites. The following article discusses general aspects of vascular access, imaging tools to facilitate access, the various access sites with technical approach, advantages, and specific complications. Strategies for vessel protection and management of acute bleeding and iatrogenic fistulas are presented. Also, strategies for vessel restoration after acute and chronic vascular occlusion are reviewed.
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Affiliation(s)
- W A K Radtke
- Pediatric Cardiology, Children's Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA.
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Nykanen DG, Zahn EM. Transcatheter techniques in the management of perioperative vascular obstruction. Catheter Cardiovasc Interv 2005; 66:573-9. [PMID: 16270363 DOI: 10.1002/ccd.20554] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The role of transcatheter intervention for the treatment of vascular obstruction is well documented in the preoperative or remote postoperative settings. More recently, the roles of angioplasty and stent implantation have been advocated as intraoperative and immediate postoperative strategies. As one considers the inherent advantages in this cooperative approach to congenital heart disease, the development of a truly hybrid interventional suite seems imperative.
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Affiliation(s)
- David G Nykanen
- Congenital Heart Institute, Miami Children's Hospital, Miami, Florida, USA.
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