The early and mid-term fate of the axillary artery following axillary artery cut-down and cardiac catheterization in infants and young children.

OBJECTIVES: To study the early and mid-term vascular complications of axillary artery catheterization in children <2 years by clinical and ultrasound examination.

BACKGROUND: Femoral arterial access for cardiac catheterization in young children is associated with significant morbidity. Early complications of axillary artery catheterization have been reported but no long-term vascular follow-up data are available.

METHODS: Prospective case-control study using standard vascular ultrasound techniques to examine the upper limbs in study participants (n = 10).

RESULTS: In total, 23% of axillary artery catheterizarions (56 procedures in 54 patients) resulted in acute arterial insufficiency requiring heparin. Of the survivors under follow-up (n = 33), none had symptoms of chronic arterial insufficiency. At a median follow-up of 8 years postprocedure, three out of the ten study participants had a weak brachial pulse in the test arm but no significant difference in arm measurements. Color Doppler revealed occlusion of the axillary artery in the test arm with collateralization in three patients. The brachial peak systolic velocity (V(max)) was significantly lower in the test arm than the control arm of all the patients with a mean difference of 30 cm/sec (P = 0.007).

CONCLUSION: Our study is the first to examine the long-term vascular sequelae of axillary artery catheterization using ultrasound examination and highlights the importance of careful surveillance of vascular access sites. Although axillary artery cut-down for cardiac catheterization in infants and young children does not appear to result in clinical signs of chronic arterial insufficiency, we demonstrate clear evidence of flow abnormalities on vascular ultrasound which are of uncertain long-term significance.