Sachin Tadphale, MPH, MBBS, FAAP
Assistant Professor
University of Tennessee Le Bonheur Children's Hospital
Memphis, Tennessee
Disclosure information not submitted.
Kaitlin Ryan, MD
Assistant Professor of Pediatrics
University of Tennessee Health Science Center, Tennessee, United States
Disclosure information not submitted.
B Waller, II, MD
Professor of Pediatrics
University of Tennessee Health Science Center, Tennessee, United States
Disclosure information not submitted.
Shyam Sathanandam, MD
Associate Professor of Pediatrics
University of Tennessee Health Science Center, Tennessee, United States
Disclosure information not submitted.
Title: Distal Limb Perfusion in Cardiac Catheterization Using Arterial Access in Children: A Pilot Study
Introduction: Arterial access during cardiac catheterization in children can effect distal limb tissue perfusion; the risk factors for which are unknown. Complications from arterial access ranges from acute occlusive injury, motor or sensory deficits, limb length discrepancy to ischemia requiring limb amputation. The objectives of this study were to measure changes in distal limb perfusion and identify risk factors for decreased perfusion in children during cardiac catheterization.
Methods: A prospective pilot study of distal limb perfusion during pediatric cardiac catheterizations from August 2016 through May 2017. Laser Doppler flowmetry was used to continuously measure perfusion using real-time, measured as tissue RBC fluxes. The percentage difference in the Pre-to-Immediate Post-Procedure, as well as the Pre-to-6 hour Post Procedure flux were calculated. The ratio of the outer diameter of the arterial sheath (OD) to the luminal diameter of the cannulated artery (AD) – OD/AD ratio was calculated. Risk factors for the greatest change in flux during a procedure were determined.
Results: Limb perfusion was continuously measured in 72 during cardiac catheterization. The percent change in perfusion from Pre-to-Immediate Post Procedure in accessed limb was -30 (+ 21%) and 20 (+ 8%) for non-accessed limb (P < 0.001). There was a significant difference in the immediate post procedure flux in the accessed versus non-accessed limbs (25+ 18, and 44 + 22, p < 0.001). An OD/AD ratio > 50% and femoral artery diameter less than 3mm were associated with significant decrease in tissue perfusion (P < 0.001). Pulse loss was not encountered in any patient.
Conclusions: This pilot study is the first to determine real time changes in distal limb tissue perfusion in children during cardiac catheterization using arterial access; the clinical implications of which are still uncertain. The knowledge that an OD/AD ratio > 50% and femoral artery diameter less than 3mm could significantly affect limb perfusion may be useful for practitioners in preventing any long term sequelae from these procedures.