Scholars@Duke publication: Routine Use of Ultrasound in the Identification and Management of Thrombosis Following Pediatric Cardiac Catheterization.

Routine Use of Ultrasound in the Identification and Management of Thrombosis Following Pediatric Cardiac Catheterization.

Publication , Journal Article

Critchfield, DR; Fleming, GA; Hill, KD; Chamberlain, RC

Published in: Catheter Cardiovasc Interv

October 3, 2025

BACKGROUND: Vessel occlusion post-catheterization is a common complication, yet there is no standard for diagnosis and treatment. As a result, there is variability in identification and management of post-catheterization thrombosis. AIMS: We aimed to (1) describe a protocol using ultrasound (US) for the identification and managemetn of venous and arterial thrombosis and (2) evaluate risk factors for post-catheterization thrombosis. METHODS: Single-center, retrospective review of patients ≤ 6 months undergoing cardiac catheterization from 2015 to 2020 following implementation of a surveillance and treatment protocol with routine US. We collected demographics, procedural and treatment details, and outcomes for protocol effectiveness. Mixed-effect multivariate logistic regression identified risk factors associated with venous and arterial thrombosis. RESULTS: In total, 320 patients underwent 443 catheterizations with a mean age 2.9 months and weight 4.6 kg. A total of 755 vessels were accessed and US was obtained in 641/755 (84.9%) with thrombosis detected in 59/641 (9.2%); 26/338 (7.7%) venous and 33/303 (10.9%) arterial. In multivariate analysis, fluoroscopy time (aOR 1.02 per minute, CI 1.00-1.04) and smaller sheath size (aOR 0.48 per 1 French size, CI 0.26-0.83) predicted venous thrombosis. While larger sheath size (aOR 3.60 per 1 French size, CI 1.13-11.32) and lower weight (aOR 0.58 per kg, CI 0.41-0.82) were predictive for arterial thrombosis. Nearly all thrombi (56/59, 94.9%) were treated and thrombus resolution was noted in most (17/26, 65.4% venous, 27/33, 81.8% arterial). Of patients undergoing a future catheterization, a vessel with previous thrombosis was accessed in 14/23 (60.9%) venous and 15/30 (50.0%) arterial sites. CONCLUSIONS: A protocol of routine post-catheterization US and thrombus treatment in infants commonly identified venous and arterial thrombi-resolving the majority of thrombi identified.