Introduction: The frequency of percutaneous interventions to treat pediatric congenital heart diseases has increased due to the risks associated with surgeries. The challenge of arterial access in children, especially through femoral access, has led to the search for alternatives such as carotid artery access (CA) and axillary arterial puncture (AAP), the latter gaining preference for its safety and low complication rate.

Objectives: To evaluate the experience with AAP in the pediatric age group at a quaternary hospital.

Methods: Descriptive analysis of medical record data of children undergoing catheterization from 2013 to 2023 who underwent AAP during the procedure and their immediate complications.

Results: A total of 66 patients undergoing AAP during catheterization were identified, with 41 (62.1%) being male, and the mean weight and age were 11.34 kg (2.6 - 32 kg) and 2.3 years (17 days - 8.7 years), respectively. The evaluation of the Catheterization RISk score for Pediatrics (CRISP) showed that the majority of patients had a risk score of 3 (40.9%) and 4 (24.2%). Ultrasound-guided puncture was performed in 77.3% cases, and patients received an average of 88.8 IU/kg of heparin, with protamine used in 18.2% cases. The introducers used were 5 Fr (54.5%), 6 Fr (12.1%), 7 Fr (19.7%), 8 Fr (12.1%), and 10 Fr (1.5%), with introducer exchanges performed in 27.3% of procedures. The main procedures performed included aortoplasty, central shunt or modified Blalock-Taussig angioplasty, stent placement in ductus arteriosus in pulmonary dependent circulation, and diagnostic catheterizations. Seven complications related to AAP were identified, including 4 bleedings, 2 hematomas, and 1 acute arterial occlusion (AAO). There was no need for transfusion due to bleeding. The patient with AAO was male, weighing 18 kg, and received a 10 Fr introducer. Ultrasound showed distal filling of the axillary artery by collaterals, and no percutaneous intervention was required. The patient was anticoagulated with complete recovery of axillary flow in his clinical course.

Conclusion: AAP is a feasible vascular access in the pediatric age group, allowing the treatment and diagnosis of lesions without the need for intracardiac manipulations that could cause some degree of instability in patients with higher CRISP scores. From the sample of patients undergoing puncture, one presented a serious complication with AAO, but showed improvement after clinical treatment.