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Pediatric postmortem CT angiography: validation of vascular access for PMCT angiography in stillbirths, babies and toddlers

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Název: Pediatric postmortem CT angiography: validation of vascular access for PMCT angiography in stillbirths, babies and toddlers
Autoři: G. M. Bruch, P. Hofer, L. F. Ferraz da Silva, J. R. Pires-Davidson, G. A. Bento dos Santos, F. T. Fischer
Zdroj: Forensic Sci Med Pathol
Informace o vydavateli: Springer Science and Business Media LLC, 2023.
Rok vydání: 2023
Témata: Male, Umbilical Veins, Computed Tomography Angiography, Infant, Newborn, Infant, Contrast Media, Stillbirth, Femoral Vein, 3. Good health, Femoral Artery, Intraosseous access, Original Article, Umbilical vascular access, Femoral vascular access, Pediatric postmortem angiography, PMCTA, Child, Preschool, Catheterization, Peripheral, Humans, Female, Autopsy
Popis: Purpose The use of angiography in postmortem CT angiography (PMCTA) has several advantages. In adults, femoral vascular access is well established. Due to the small and specific anatomy in fetuses and infants, the technique has to be adapted, especially regarding the vascular access. The aim of this study was to evaluate vascular access for pediatric PMCTA (pedPMCTA). Materials and Methods Ten pedPMCTAs were performed in stillbirths, babies, and one toddler. A femoral approach by cannulation of the femoral artery and vein, an umbilical approach by cannulation of the umbilical vessels, and an intraosseous approach by an intraosseous needle were evaluated by handling and resulting imaging. Results The insertion of a cannula with a size of 18–20 G in the femoral vessels was possible in babies. An umbilical access with peripheral venous cannulas with a size of 14–20 G was feasible in stillbirths and newborns. An intraosseous access is advisable as equal alternative to umbilical and in cases where a femoral access is not possible. The most significant problem with the vascular access is the extravasation of contrast media, but this can be reduced significantly with practice. Conclusion When performing pedPMCTA, an umbilical vascular access is recommended if an umbilical cord with open vessels is still present. Otherwise, a bone marrow access should be preferred in the presence of an arteriovenous shunt or if only the venous system needs to be shown. If that is not the case, the femoral access with the possibility to separate venous and arterial scan should be used.
Druh dokumentu: Article
Other literature type
Jazyk: English
ISSN: 1556-2891
DOI: 10.1007/s12024-023-00726-y
Přístupová URL adresa: https://pubmed.ncbi.nlm.nih.gov/37812319
https://repository.publisso.de/resource/frl:6523914
Rights: CC BY
Přístupové číslo: edsair.doi.dedup.....237451ba51d752a7907dffd245361d2f
Databáze: OpenAIRE
Popis
Abstrakt:Purpose The use of angiography in postmortem CT angiography (PMCTA) has several advantages. In adults, femoral vascular access is well established. Due to the small and specific anatomy in fetuses and infants, the technique has to be adapted, especially regarding the vascular access. The aim of this study was to evaluate vascular access for pediatric PMCTA (pedPMCTA). Materials and Methods Ten pedPMCTAs were performed in stillbirths, babies, and one toddler. A femoral approach by cannulation of the femoral artery and vein, an umbilical approach by cannulation of the umbilical vessels, and an intraosseous approach by an intraosseous needle were evaluated by handling and resulting imaging. Results The insertion of a cannula with a size of 18–20 G in the femoral vessels was possible in babies. An umbilical access with peripheral venous cannulas with a size of 14–20 G was feasible in stillbirths and newborns. An intraosseous access is advisable as equal alternative to umbilical and in cases where a femoral access is not possible. The most significant problem with the vascular access is the extravasation of contrast media, but this can be reduced significantly with practice. Conclusion When performing pedPMCTA, an umbilical vascular access is recommended if an umbilical cord with open vessels is still present. Otherwise, a bone marrow access should be preferred in the presence of an arteriovenous shunt or if only the venous system needs to be shown. If that is not the case, the femoral access with the possibility to separate venous and arterial scan should be used.
ISSN:15562891
DOI:10.1007/s12024-023-00726-y