Stenting the vertical ductus arteriosus via axillary artery access using "wire-target" technique

Area of Science:

• Pediatric Cardiology
• Interventional Cardiology
• Neonatal Medicine

Background:

• Neonates with duct-dependent pulmonary circulations often require intervention for a vertical ductus arteriosus.
• Transvenous stent placement via the femoral vein is a common approach.
• Alternative access routes may offer improved outcomes.

Purpose of the Study:

• To review outcomes of stent placement in neonates with a vertical ductus arteriosus.
• To present and evaluate a technique for ductal stenting via the axillary artery.
• To compare axillary artery access with femoral venous access for ductal stenting.

Main Methods:

• Retrospective review of 19 neonates with duct-dependent pulmonary circulations.
• Stent implantation performed via femoral venous access in the first nine patients.
• Stent implantation performed via axillary artery access using a wire-target technique in the subsequent ten patients.

Main Results:

• Successful stenting was achieved in 6/9 (67%) cases via femoral vein access versus 10/10 (100%) cases via axillary artery access (P=0.047).
• The wire-target technique was successful in all ten axillary artery access cases.
• Fluoroscopy and total procedure times were significantly shorter with axillary artery access (P<0.001).

Conclusions:

• Stenting of a vertical ductus arteriosus via the axillary artery using a wire-target technique is feasible and safe.
• Axillary artery access offers a promising alternative to femoral venous access for ductal stenting in selected neonates.
• This technique may lead to improved procedural efficiency and success rates.