Transradial coronary angiography in children and adolescents

Radial arterial access for coronary angiography is widely used in adults. We aimed to determine its safety and feasibility in pediatric practice. Twelve children and adolescents post cardiac transplantation (13 procedures) were studied. The radial artery was cannulated with a 5-Fr sheath after subcutaneous injection of 2% lidocaine. A mixture of verapamil, heparin, and isosorbide dinitrate was administered to reduce spasm. Selective coronary angiograms were obtained using Judkin or Amplatz coronary catheters. Following the procedure, hemostasis was achieved with a TR Band. Median age was 16.7 years (range, 12.1-18.8 years), and median weight 55.2 kg (range, 39-81 kg). Seventy percent of cases were under local anesthetic. Radial access was successful in 85%. Severe arterial spasm led to abandonment in one and failure to complete the study adequately in two patients. No vascular complications occurred. On direct questioning all but one patient preferred the radial approach. We conclude that the radial approach to coronary angiography is safe and feasible in children and adolescents. Radial artery spasm can be a problem and difficult to reverse once it occurs, leading to procedure abandonment. However, the technique is successful in the majority of cases and provides an alternative approach to arterial access in this age group.