"Wire-target" technique for precise vascular access

Herein, we describe a technique that facilitates percutaneous vascular access when the traditional method of achieving access is unsuccessful. For multiple reasons, gaining access to small vessels in pediatric patients is sometimes difficult. In instances of atrial, ventricular, or great arterial communications, a wire can be positioned from a vein or artery across the communications into an artery or vein to which access needs to be gained. This wire then serves as a target for vascular access. All pediatric patients who underwent cardiac catheterization at Mattel Children's Hospital from July 2003 through June 2006, and at Rady Children's Hospital from July through December 2006, were considered for the wire-target technique when access could not be achieved in vessels of interest via traditional methods. Fifteen wire-target procedures were undertaken in 14 patients (ages, 4 d-11 yr). By use of a directional catheter, a Wholey or 0.014-inch coronary wire was positioned in a vessel to which access was desired. Anterior-posterior and lateral fluoroscopic views were used to target the wire and attain vascular access. The patients' diagnoses, ages, vessels to which access was gained via traditional methods and via the wire-target technique, and wire routes were retrospectively recorded, and outcomes were noted. In all instances, the technique was performed successfully and without complications. In selected pediatric patients in whom percutaneous vascular access is difficult, the wire-target technique may be used safely and effectively to establish arterial, venous, or transhepatic access.