Common femoral artery occlusions develop not infrequently in the infants and small children after endovascular catheterizations. Seldinger technique, albeit commonly accepted method, may have negative consequences for a femoral artery, especially in the newborns. A considerable proportion of neonates may experience a transient loss of peripheral arterial pulsation in the first hours after the intervention and some of them carry on with femoral artery occlusions. The article describes two groups of patients who have undergone cardiac catheterizations in their early life, developed common femoral artery occlusions and presented collateral arterial supply to the legs in the remote period.
In the first case, a 9-year old girl has been examined. She underwent aortic coarctation balloon angioplasty at the age of 1.5 years. In next five years she experienced pains in her right leg, which eventually vanished. She was suspected to have a gothic aortic arch and underwent aortography in 2017. In the presentation, her lower limbs are symmetric and her blood pressures are the following: arms – 135/75 mmHg, left shin – 145/75 mmHg, right shin – 135/80 mmHg. As soon as gothic arch pattern has been suspected, an aortography has been planned. Insertion of the catheter through the right femoral artery has been failed and the procedure has been performed on the left side. During the angiography, a collateral network bypassing the occlusion site of the right femoral artery has been visualized.
In the second case, a 12-year old girl has been investigated. The patient had diagnostic catheterization performed at the age of one month. She had a D-transposition of the great arteries and ventricular septal defect and underwent the arterial switch and defect closure surgery in the neonatal period. The girl underwent routine coronarography in 2017. In the presentation, her lower limbs are symmetric and her blood pressures are the following: arms – 130/80 mmHg, left shin – 160/110 mmHg, right shin – 130/90 mmHg. Insertion of the catheter through the right femoral artery has been failed and the procedure has been performed on the left side. The angiogram has depicted the right common femoral artery occlusion with gross collateralization to the thigh.
The collateral arterial circulation to the leg after the post-catheterization occlusion consists of two major patterns – medial and lateral. The medial network comes from the obturator and internal pudendal arteries (internal iliac artery), both feed the medial circumflex femoral artery. The lateral network is supplied by the superior and inferior gluteal arteries (internal iliac artery) and deep circumflex iliac artery (external iliac artery) meeting the ascending branch of lateral circumflex femoral artery. As a result, medial and lateral circumflex femoral arteries nourish a deep femoral artery with arterial blood to fill the common femoral artery retrogradely. The effectiveness of the collateralization in these cases has been determined by a limited extent of the obstruction and location of the occlusion in the main artery, patency of the collaterals and stable hemodynamics just after the invasive procedure to push the blood through the tiny vessels. Further the collaterals dilate and provide limb with adequate blood supply.
Article recieved: 15.06.2017
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