Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, M5G 1X8, Canada.
Neuroradiology. 2021 Apr;63(4):633-635. doi: 10.1007/s00234-021-02664-4. Epub 2021 Feb 9.
Pediatric neuroendovascular procedures require special considerations. Given small vessel sizes, risk for arterial injury must be weighed against use of larger devices, with the diameter of the sheath being a known association with arterial complications. We recently transitioned to using thin-walled radial sheaths for transfemoral angiography in children, given their lower profile. Here, we report on these sheaths' technical success and complications, comparing against a historical cohort where regular vascular sheaths were employed.
We retrospectively recorded patient and procedural data from 168 consecutive procedures from September 2017 to January 2019 when radial-specific sheaths were exclusively used at our tertiary pediatric hospital. These results were compared to data from September 2015 to January 2017, when regular vascular sheaths were exclusively used in 152 consecutive procedures. Statistical analysis was performed using unpaired t test or chi-square test, with p < 0.05 considered statistically significant.
Patient characteristics (age, sex, weight) were not statistically different between the case and control group. No significant differences were found in the procedural data with the exception of heparin use which was higher in the radial-sheath cohort. There was a decrease in the rate of complications in the case group (1.2%) versus control group (2.6%), though not statistically different.
Radial-specific sheaths have numerous beneficial characteristics that make them well-suited to the pediatric population. In our study, we show that radial sheaths are equally effective and safe perioperatively. Follow-up research may show if radial sheaths used transfemorally decrease long-term complications such as limb-length discrepancy and mortality.
儿科神经血管介入操作需要特殊考虑。由于血管直径较小，必须权衡使用较大器械的风险，鞘管直径是与动脉并发症相关的已知因素。鉴于薄壁径向鞘管的外径较小，我们最近开始在儿童经股动脉血管造影中使用这种鞘管。在此，我们报告了这些鞘管的技术成功率和并发症，并与使用常规血管鞘管的历史队列进行了比较。
我们回顾性地记录了 2017 年 9 月至 2019 年 1 月期间在我们的三级儿科医院连续 168 例使用径向专用鞘管的患者和手术数据。这些结果与 2015 年 9 月至 2017 年 1 月期间使用常规血管鞘管连续 152 例的资料进行了比较。使用独立样本 t 检验或卡方检验进行统计学分析，p<0.05 被认为具有统计学意义。
病例组和对照组患者的特征（年龄、性别、体重）在统计学上没有差异。除肝素使用外，两组的手术数据没有显著差异，肝素使用在径向鞘组更高。病例组并发症发生率（1.2%）低于对照组（2.6%），但无统计学差异。
径向专用鞘管具有许多有益的特点，使其非常适合儿科人群。在我们的研究中，我们表明径向鞘管在围手术期同样有效且安全。进一步的研究可能会显示经股动脉使用径向鞘管是否会降低长期并发症，如肢体长度差异和死亡率。
