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Construction of Femoral Vessel Nomograms for Planning Cardiac Interventional Procedures in Children 0-4 Years Old
Sachin D Tadphale1, David Zurakowski2, Lindsey E Bird3
1Department of Pediatrics, Division of Pediatric Cardiology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 49 N Dunlap Ave, FOB #348, Memphis, TN, 38103, USA. stadphale@uthsc.edu.
Insights
This study created femoral artery and vein nomograms for children aged 0-4 years, aiding in cardiac catheterization planning. Probability curves for arterial access complications were also developed, improving interventional strategies.
Area of Science:
- Pediatric Cardiology
- Vascular Ultrasound
- Interventional Radiology
Background:
- Femoral artery (FA) and femoral vein (FV) access is crucial for pediatric cardiac catheterizations in congenital heart disease (CHD).
- Current literature lacks established nomograms for pediatric femoral vessel dimensions based on age or size.
- This knowledge gap hinders precise interventional planning and risk assessment.
Purpose of the Study:
- To develop nomograms for femoral artery and vein dimensions in children aged 0-4 years.
- To create probability curves for arterial access complications, specifically loss of pulse (LOP), related to FA size.
- To provide data supporting improved interventional planning for pediatric cardiac procedures.
Main Methods:
- Prospective study involving 400 children (0-4 years) with CHD undergoing cardiac catheterization.
- Pre-procedural ultrasound assessment of bilateral FA and FV diameters and cross-sectional areas under anesthesia.
- Application of quantile polynomial regression and GAMLSS transformation for nomogram construction; separate prospective evaluation for FA LOP probability.
Main Results:
- Established ultrasound-based nomograms for FA and FV diameter and cross-sectional area against age and body surface area in children 0-4 years.
- Constructed probability curves for FA LOP, identifying critical vessel size thresholds.
- Demonstrated good fit of regression models to the collected data.
Conclusions:
- Ultrasound-derived femoral vessel nomograms and LOP probability curves are now available for children aged 0-4 years.
- These tools can assist clinicians in interventional planning and risk stratification for pediatric cardiac catheterizations.
- Future research with larger, diverse age groups is recommended to expand these findings.
Abstract:
The objectives of this study were to construct femoral artery (FA) and femoral vein (FV) nomograms in children aged 0-4 years and to construct probability curves for the occurrence of arterial access complications based on the size of the FA. The FV and FA are commonly accessed during cardiac catheterizations in children with congenital heart diseases (CHD). However, nomograms for vessel dimensions based on child's age or size are not available. This knowledge may be helpful for interventional planning. A prospective study was performed on 400 children (age 0-4 years) with CHD undergoing cardiac catheterizations over a 3-year period. Ultrasound evaluation of the right and left FA and FV was performed under anesthesia prior to vascular access. Regression modeling was applied to derive nomograms based on quantile polynomial regression, which yielded good fit to the data judged by R-squared. GAMLSS transformation method was used to formulate smoothed percentiles. A separate prospective evaluation of FA to determine the size below which loss of pulse (LOP) are likely to occur was performed. Nomograms for FA and FV diameter and cross-sectional area against age and body surface area and probability curves for FA LOP were constructed. It is now possible to examine ultrasound-based normal sizes of femoral vein and artery in children 0-4 years of age. Femoral vessel nomograms and LOP probability curves may help with interventional planning. Future studies with larger sample size, including children of other ages may be useful.
