The Impact of Vascular Access Sidedness on the Incidence of Local Vascular Complications in Elective Congenital Cardiac Catheterization Procedures Requiring Simultaneous Arterial and Venous Sheaths

Background: Local vascular complications in pediatrics undergoing congenital cardiac catheterization are consistently reported to be the commonest regardless of the access type and side. Methods: This is a retrospective study with data collection of multidetector computed tomography studies performed between 2016 and 2019 from 3 large cardiac centers in our country. Results: Totally, 190 patients who required both arterial and venous access sites were randomization into Group I or the planned ipsilateral group (the planned insertion of both arterial and venous sheaths in the same limb), Group II or the planned contralateral group (the planned insertion of arterial and venous sheaths in different limbs), and Group III or the unplanned group (unplanned vascular access sidedness after the failure of initial randomization). The incidence and types of local vascular complications during the hospital stay were recorded. Patients with the unplanned vascular access site had a higher incidence of local vascular complications, longer hospital stays, with higher needs for heparin and thrombolytic therapy than patients with the planned vascular access site. Patients with a systematically planned contralateral access site showed a lower incidence of arterial thrombosis, delayed capillary refilling time, and arteriovenous fistula, as well as lower needs for heparin and thrombolytic administration than patients with the planned ipsilateral vascular access site. Conclusions: Systematic planned contralateral vascular access in patients who undergo congenital heart disease catheterization requiring both arterial and venous sheaths is associated with a lower incidence of vascular complications, especially in patients weighing less than 10 kg.