Femoral Arterial Access in Pediatric Diagnostic Angiography and Endovascular Interventions: Predictors of Technical Success, Adverse Events and Thrombotic Risk
Bibliographic record
Abstract
## Introduction To identify predictors of technical success and adverse events (AEs) associated with ultrasound (US)-guided femoral arterial (FA) access in children undergoing diagnostic angiography and interventions. ## Materials and Methods Retrospective study including consecutive FA access attempts aged ≤18 years at a tertiary pediatric hospital between January 2018 and December 2024. Baseline demographics, corrected FA diameter and technical details were analysed using univariable and multivariable Firth logistic regression to identify predictors of technical success and AEs. ## Results 661 US-guided FA access were attempted in 311 patients. Median age was 7.9 years (range, 0.09–17.9), and median corrected FA diameter was 4.6 mm (range, 1.2–9.6). 49.8% (329/661) accesses were for interventions. Technical success was 99.2% (656/661). The overall AE rate was 5.4% (36/661), with 1.7% (11/661) SIR moderate and severe grades. Vasospasm, more common in arteries ≤3.9 mm, was associated with both access failure and thrombosis. Prophylactic intra-arterial nitroglycerin significantly reduced vasospasm risk (P < .001). Arterial thrombosis occurred in 0.9% (6/661) of accesses, with median age of 0.3 years, weight of 6.4 kg and corrected FA diameter of 1.7mm. All cases were managed anticoagulation, with no permanent ischemic sequelae. Independent predictors of thrombosis included sheath-to-artery (S/A) ratio ≥1 (P<.001) and use of vascular closure device (VCD) (P=.02). Hematoma was associated with ≥6 French sheath and body weight ≥75 kg (P<.001). ## Discussion US-guided FA access has a high success and low AE rate in children. Pre-procedural US assessment, careful sheath selection and prophylactic intra-arterial nitroglycerin can help improve outcome. VCD should be used with caution in children.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".