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Transradial approach for pediatric interventions: A review and analysis of the literature
Derrek Schartz1,2, Emily Young1,2, Stephen Guerin1,2
1Geisel School of Medicine at Dartmouth College, Hanover, NH, USA.
Insights
Transradial access in pediatric patients shows a 91% success rate but a higher complication rate than transfemoral access. However, complications requiring surgery may be lower, warranting further investigation.
Area of Science:
- Pediatric Interventional Cardiology
- Vascular Access Techniques
- Minimally Invasive Procedures
Background:
- Transradial access is established in adults but understudied in pediatric populations.
- Limited literature exists on transradial access for pediatric interventions.
Purpose of the Study:
- To systematically review and synthesize existing data on pediatric transradial access.
- To analyze the safety and efficacy of transradial access in children.
Main Methods:
- Systematic literature review of available data.
- Data synthesis and analysis of transradial access in pediatric patients.
Main Results:
- Overall success rate of 91% for pediatric transradial access.
- Complication rates: 11.4% vasospasm, 3.0% loss of pulse, 14% total.
- Lower complication rates observed for neurological indications and studies published after 2013.
Conclusions:
- Transradial access in pediatric patients has a higher complication rate than transfemoral access.
- Potential for a lower rate of surgically managed complications.
- Further research is needed to compare transradial and transfemoral access advantages in pediatric patients.
Background:
Transradial access for interventions has been well studied in the adult population, but there is a paucity of literature of its use in the pediatric population.
Methods:
We conducted a systematic literature review and gathered and synthesized all of the available data into a cohesive resource for review and analysis of the topic.
Results:
Pooled analysis of the available data shows that transradial access in pediatric patients has a success rate of 91%, a vasospasm rate of 11.4%, and loss of pulse rate of 3.0% for a total complication rate of 14%. No permanent complications, or complications requiring surgery, were observed in any study. After stratifying for indication of intervention, neurological indications were associated with a lower complication rate compared to cardiac indications (0.1 vs 0.43, respectively, p = 0.004). In addition, studies published after 2013 were associated with a lower complication rate compared to those published during or before 2013 (0.11 vs 0.33, respectively, p = 0.01).
Conclusion:
Compared to prior studies on pediatric transfemoral access, transradial access has a higher complication rate. But there may be a lower rate of complications that require surgical intervention. Further studies are needed to clarify any advantages that transradial access may have over transfemoral access for pediatric patients.
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