The authors report single-center experience with ultrasound post-cardiac catheterization to detect arterial thrombosis in patients 0–12 months of age from 2007–2016. A total of 270 patients with median weight 5.2kg underwent 509 catheterizations with 40 (7.9%) having arterial thrombosis detected. A total of 37 were detected by ultrasound, and 3 were detected by a clinical exam consistent with an occluded artery. Of ultrasound documented thrombosis, 20/37 were partial occlusions, while 17/37 were complete occlusions. In 2015 the authors had implemented a quality improvement project with ultrasound used in all patients < 6 months of age following cardiac catheterization. Previously, ultrasound was utilized only if clinical signs of arterial occlusion were present. From 2015–16, the rate of thrombus detection in patients < 6 months old increased from 8.3 to 23.4%, while the rate for the entire cohort increased from 6.4 to 15.8%. On multivariate analysis, lower weight, larger arterial sheath size, and longer procedure duration were independently associated with higher odds of thrombosis. All patients were treated medically with heparin or enoxaparin. The authors postulate routine use of ultrasound post catheterization may allow earlier detection of thrombosis before clinical signs of arterial occlusion are present, which may reduce the severity of occlusions with decreased downstream tissue injury. Further longitudinal study is recommended to evaluate the impact of routine ultrasound on thrombosis detection and patient outcomes.

All editors: Gary E. Stapleton, MD, FSCAI