Skip to main content
SIR 2026 Event Main banner

SIR 2026

Traditional Poster

Pediatric Interventions

Session: Traditional Poster Presentations

603 - Femoral Arterial Access in Pediatric Angiographic Procedures: Predictors of Technical Success, Adverse Events and Thrombotic Risk

Monday, April 13, 2026
12:10 PM - 1:10 PM ET
Purpose: To identify predictors of technical success and adverse events (AEs) associated with ultrasound (US)-guided femoral arterial (FA) access in children undergoing catheter-directed angiography and interventions.

Materials and Methods: Retrospective study including 661 consecutive FA accesses in patients aged ≤18 years (male 53% [350/661]) at a tertiary pediatric hospital between January 2020 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 (which was defined as successful placement of vascular sheath) and AEs (graded according to SIR classification).

Results: The median age was 7.9 years (range, 1.1 months – 17.9 years) and the median corrected FA diameter was 4.6mm (range, 1.2 – 9.6mm). The technical success rate was 99.2% (656/661). 49.8% [329/661] of the accesses were intended for interventions. 69% of the accesses (450/661) were performed using a 4 French vascular sheath with a median sheath-to-artery (S/A) ratio of 0.5 (IQR 0.4 – 0.6).





The overall AE rate was 5.4% (36/661), with 1.7% (11/661) classified as SIR moderate and severe grades. Vasospasm (2.0%[13/661]), which was more common in arteries with corrected diameter ≤ 3.9 mm, was associated with both access failure and thrombosis (P=.009). Prophylactic intra-arterial nitroglycerin administration significantly reduced vasospasm risk (P< .001).

Arterial thrombosis was diagnosed 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 treated with unfractionated heparin and followed by subcutaneous low molecular weighed heparin, with no ischemic sequelae (median follow up = 525.5 days; range, 169 - 1616 days). Independent predictors of thrombosis included sheath-to-artery ratio ≥1(OR 107.4 [95% CI: 7.6 – 8094.3], P< .001) and use of vascular closure device (OR 180.7 [95% CI: 2.0 – 10042.1], P=.02) . Hematoma was associated with ≥6 French sheath and body weight ≥75 kg (P< .001).

Conclusion: US-guided FA access has a high success and low AE rate in a high-volume pediatric practice. Arteries > 3.9mm and use of prophylactic intra-arterial nitroglycerin reduce risk of vasospasm and access failure. Optimisation of sheath-to-artery ratio and avoidance of VCD use can mitigate the risk of thrombosis in children.