{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T21:44:08Z","timestamp":1775252648525,"version":"3.50.1"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T00:00:00Z","timestamp":1706659200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Axillary arterial access (AAA) in pediatric heart catheterizations is undervalued.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively reviewed children with congenital heart diseases (CHDs) who received trans-axillary arterial catheterizations between January 2019 and February 2023. We aimed ultrasound-guided punctures in the proximal two-thirds of axillary arteries with diameters \u22652\u2005mm to insert 7\u2005cm\/4\u2005Fr short introducers. We administrated intra-arterial verapamil (1.25\u2005mg) and heparin (100\u2005UI\/kg). We infiltrated per-operatively 2% lignocaine (10\u2005mg) for arterial spasms, long sheaths use (\u22655\u2005Fr), and \u226560\u2005min procedures in &amp;lt;3\u2005kg patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 30 patients (66.7% males) with a median age of 1.1 months (IQR, 0.3\u20135.4), and a median weight of 3.1\u2005kg (IQR, 2.7\u20133.7). 5\/30 patients had six redo interventions after a median of 3.9 months (IQR, 1.7\u20135.1). Overall, 27\/36 procedures were interventional, including 6 aortic valvuloplasties, 6 balloon angioplasties, and 15 stenting procedures. The median arterial axillary angiographic diameter was 2.6\u2005mm (IQR, 2.4\u20133). Access was right-sided in 23\/36 (63.9%) procedures and obtained using 21G\/2.5\u2005cm bevel needles in 25\/36 (69.4%) procedures. No hemodynamical change occurred after introducing spasmolytic drugs. The median fluoroscopy time was 26.1\u2005min (IQR, 19.2\u201334.8). There were two self-resolving arterial dissections, one sub-occlusive arterial thrombosis (resolved with 6 weeks of enoxaparin), and one occlusive arterial thrombosis (resolved with alteplase thrombolysis and 6 weeks of enoxaparin). Median follow-up was 11.7 months (IQR, 8\u201317.5). Four patients with complex univentricular hearts died from non-procedural causes at a median of 40 days (IQR, 31\u2013161) postoperative.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Systematic approach for AAA is the key to success and unlocks the many potentials of trans-axillary pediatric cardiology interventions.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2024.1332152","type":"journal-article","created":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T04:29:27Z","timestamp":1706675367000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Systematic approach to obtain axillary arterial access for pediatric heart catheterizations"],"prefix":"10.3389","volume":"11","author":[{"given":"Raymond 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