Routine Use of Ultrasound in the Identification and Management of Thrombosis Following Pediatric Cardiac...

Vessel occlusion post-catheterization is a common complication, yet there is no standard for diagnosis and treatment. As a result, there is variability in identification and management of post-catheterization thrombosis.

We aimed to (1) describe a protocol using ultrasound (US) for the identification and managemetn of venous and arterial thrombosis and (2) evaluate risk factors for post-catheterization thrombosis.

Single-center, retrospective review of patients ≤ 6 months undergoing cardiac catheterization from 2015 to 2020 following implementation of a surveillance and treatment protocol with routine US. We collected demographics, procedural and treatment details, and outcomes for protocol effectiveness. Mixed-effect multivariate logistic regression identified risk factors associated with venous and arterial thrombosis.

In total, 320 patients underwent 443 catheterizations with a mean age 2.9 months and weight 4.6 kg. A total of 755 vessels were accessed and US was obtained in 641/755 (84.9%) with thrombosis detected in 59/641 (9.2%); 26/338 (7.7%) venous and 33/303 (10.9%) arterial. In multivariate analysis, fluoroscopy time (aOR 1.02 per minute, CI 1.00-1.04) and smaller sheath size (aOR 0.48 per 1 French size, CI 0.26-0.83) predicted venous thrombosis. While larger sheath size (aOR 3.60 per 1 French size, CI 1.13-11.32) and lower weight (aOR 0.58 per kg, CI 0.41-0.82) were predictive for arterial thrombosis. Nearly all thrombi (56/59, 94.9%) were treated and thrombus resolution was noted in most (17/26, 65.4% venous, 27/33, 81.8% arterial). Of patients undergoing a future catheterization, a vessel with previous thrombosis was accessed in 14/23 (60.9%) venous and 15/30 (50.0%) arterial sites.

A protocol of routine post-catheterization US and thrombus treatment in infants commonly identified venous and arterial thrombi-resolving the majority of thrombi identified.