Arterial complications associated with cardiac catheterization in pediatric patients with a previous history of Kawasaki disease

Rebecca C. Gurofsky, Tarun Sabharwal, Cedric Manlhiot, Andrew N. Redington, Lee N. Benson, Nita Chahal, Brian W. McCrindle

Research output: Contribution to journalArticle

Abstract

Objectives: To determine whether patients with Kawasaki Disease (KD) undergoing percutaneous catheter angiography were at increased risk of arterial complications at the point of arterial access compared to patients with structural heart abnormalities, but normal vessels. Background: Systemic arterial damage can occur as a result of KD. Methods: Medical histories of all patients with KD undergoing percutaneous catheter angiography at The Hospital for Sick Children between January 1990 and August 2008 were reviewed. Results: A total of 44 patients with KD underwent 82 catheter procedures. Of these, 3 were associated with important arterial complications (2 males; age: 4 months, 3 and 17 years). All patients who experienced complications had multiple large and/or giant coronary artery aneurysms and two were within 3 months of the acute phase of KD. All patients developed pseudoaneurysms of the femoral artery which had been utilized for catheter access. All pseudoaneurysms were treated with ultrasound-guided thrombin injection and compression, and resolved with no long-term complications. One patient also developed a substantial arteriovenous fistula of the femoral circulation which had to be surgically repaired with no permanent sequels. Odds for arterial complications in patients with KD were 10.4 times greater (95%Cl: 3.2-33.8) than that noted for the general pediatric cardiac catheterization population (3.6% vs. 0.4%, P < 0.0001) which indicates higher risk associated with arterial access in patients with KD. Conclusions: Greater care in obtaining arterial access for angiography is warranted, especially in the first month directly following the acute phase possibly related to systemic arterial damage associated with KD.

Original languageEnglish (US)
Pages (from-to)809-813
Number of pages5
JournalCatheterization and Cardiovascular Interventions
Volume73
Issue number6
DOIs
StatePublished - May 1 2009
Externally publishedYes

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Vascular Surgical Procedures
Interventional Ultrasonography
Coronary Aneurysm
Doppler Color Ultrasonography
Mucocutaneous Lymph Node Syndrome
Congenital Heart Defects
False Aneurysm
Arteriovenous Fistula
Preschool Children
Femoral Artery
Cardiac Catheterization
Coronary Angiography
Thrombin
Fistula
Angiography
Thrombosis
Retrospective Studies
Odds Ratio
Pediatrics
Pressure

Keywords

  • Angiography
  • Fistula
  • Pseudoaneurysm
  • Thrombosis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Arterial complications associated with cardiac catheterization in pediatric patients with a previous history of Kawasaki disease. / Gurofsky, Rebecca C.; Sabharwal, Tarun; Manlhiot, Cedric; Redington, Andrew N.; Benson, Lee N.; Chahal, Nita; McCrindle, Brian W.

In: Catheterization and Cardiovascular Interventions, Vol. 73, No. 6, 01.05.2009, p. 809-813.

Research output: Contribution to journalArticle

Gurofsky, Rebecca C. ; Sabharwal, Tarun ; Manlhiot, Cedric ; Redington, Andrew N. ; Benson, Lee N. ; Chahal, Nita ; McCrindle, Brian W. / Arterial complications associated with cardiac catheterization in pediatric patients with a previous history of Kawasaki disease. In: Catheterization and Cardiovascular Interventions. 2009 ; Vol. 73, No. 6. pp. 809-813.
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N2 - Objectives: To determine whether patients with Kawasaki Disease (KD) undergoing percutaneous catheter angiography were at increased risk of arterial complications at the point of arterial access compared to patients with structural heart abnormalities, but normal vessels. Background: Systemic arterial damage can occur as a result of KD. Methods: Medical histories of all patients with KD undergoing percutaneous catheter angiography at The Hospital for Sick Children between January 1990 and August 2008 were reviewed. Results: A total of 44 patients with KD underwent 82 catheter procedures. Of these, 3 were associated with important arterial complications (2 males; age: 4 months, 3 and 17 years). All patients who experienced complications had multiple large and/or giant coronary artery aneurysms and two were within 3 months of the acute phase of KD. All patients developed pseudoaneurysms of the femoral artery which had been utilized for catheter access. All pseudoaneurysms were treated with ultrasound-guided thrombin injection and compression, and resolved with no long-term complications. One patient also developed a substantial arteriovenous fistula of the femoral circulation which had to be surgically repaired with no permanent sequels. Odds for arterial complications in patients with KD were 10.4 times greater (95%Cl: 3.2-33.8) than that noted for the general pediatric cardiac catheterization population (3.6% vs. 0.4%, P < 0.0001) which indicates higher risk associated with arterial access in patients with KD. Conclusions: Greater care in obtaining arterial access for angiography is warranted, especially in the first month directly following the acute phase possibly related to systemic arterial damage associated with KD.

AB - Objectives: To determine whether patients with Kawasaki Disease (KD) undergoing percutaneous catheter angiography were at increased risk of arterial complications at the point of arterial access compared to patients with structural heart abnormalities, but normal vessels. Background: Systemic arterial damage can occur as a result of KD. Methods: Medical histories of all patients with KD undergoing percutaneous catheter angiography at The Hospital for Sick Children between January 1990 and August 2008 were reviewed. Results: A total of 44 patients with KD underwent 82 catheter procedures. Of these, 3 were associated with important arterial complications (2 males; age: 4 months, 3 and 17 years). All patients who experienced complications had multiple large and/or giant coronary artery aneurysms and two were within 3 months of the acute phase of KD. All patients developed pseudoaneurysms of the femoral artery which had been utilized for catheter access. All pseudoaneurysms were treated with ultrasound-guided thrombin injection and compression, and resolved with no long-term complications. One patient also developed a substantial arteriovenous fistula of the femoral circulation which had to be surgically repaired with no permanent sequels. Odds for arterial complications in patients with KD were 10.4 times greater (95%Cl: 3.2-33.8) than that noted for the general pediatric cardiac catheterization population (3.6% vs. 0.4%, P < 0.0001) which indicates higher risk associated with arterial access in patients with KD. Conclusions: Greater care in obtaining arterial access for angiography is warranted, especially in the first month directly following the acute phase possibly related to systemic arterial damage associated with KD.

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