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Published on: August 8, 2025
Ultrasound-guided transaxillary access for diagnostic and interventional arteriography in children
Derek J Roebuck1, Kani Vendhan, Alex M Barnacle
1Department of Radiology, Great Ormond Street Hospital, London WC1N 3JH, United Kingdom. derek_roebuck@hotmail.com
Insights
Transaxillary arteriography is a feasible and safe alternative for pediatric arteriograms when femoral access is not possible. This approach demonstrated a low complication rate in children, offering a viable option for challenging cases.
Area of Science:
- Pediatric Interventional Radiology
- Vascular Access Techniques
- Diagnostic Imaging in Children
Background:
- Pediatric arteriograms commonly use femoral access.
- Alternative arterial access sites are sometimes necessary for pediatric arteriography.
- Transaxillary arteriography is a known procedure in adult patients.
Purpose of the Study:
- To evaluate the feasibility of transaxillary arteriography in pediatric patients.
- To assess the safety and complication profile of transaxillary arterial access in children.
- To establish transaxillary arteriography as a viable alternative in pediatric vascular interventions.
Main Methods:
- Retrospective review of 25 transaxillary arteriography procedures in 19 children (7 days to 15 years old) over 10 years.
- Analysis of demographic data, procedural indications, technical aspects, and complications.
- Ultrasound-guided access was utilized for all procedures.
Main Results:
- Transaxillary access was successful in all 25 procedures.
- No neurologic or bleeding complications directly related to arterial access were observed.
- Two access site complications (8%) occurred: one pseudoaneurysm and one axillary artery dissection, both without permanent sequelae.
Conclusions:
- Ultrasound-guided transaxillary access is a feasible option for pediatric arteriography when femoral access is contraindicated or technically challenging.
- While major complications are rare, the possibility of subtle postoperative nerve injury cannot be entirely excluded.
- This technique provides a valuable alternative for pediatric vascular imaging and intervention.
Purpose:
Most pediatric arteriograms are obtained from a femoral approach; alternative access sites are sometimes needed. Transaxillary arteriography is an established procedure in adults. The purpose of this study was to establish the feasibility and safety of this procedure in children.
Materials And Methods:
All children who underwent arteriography involving axillary access during a 10-year period were reviewed for demographic details, indications, technical aspects of the procedure, and complications. Twenty-five procedures were performed in 19 children aged between 7 days and 15 years (median, 4.8 years). The children weighed between 2.6 and 47 kg (median, 15 kg). Indications for use of the axillary artery were absolute (including aortic or bilateral iliac artery occlusion) in 15 (60%) and relative (including more favorable angle for thoracic or abdominal intervention) in 10 (40%). Two procedures (8%) were purely diagnostic arteriography procedures.
Results:
Transaxillary access was successful in all cases. The largest sheath used (7-F) had an outer diameter of 2.7 mm. One child died of a postoperative complication unrelated to the arterial access. There were no neurologic or bleeding complications related to the access site. Two access site complications (8%) occurred-one pseudoaneurysm and one axillary artery dissection-but neither resulted in permanent adverse sequelae.
Conclusions:
Ultrasound-guided transaxillary access is feasible for arteriography in children when femoral access is impossible or unfavorable for technical reasons. Although major complications are unlikely, this study does not exclude the possibility of subtle postoperative nerve injury.
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