Posterior Tibial Artery as an Alternative to the Radial Artery for Arterial Cannulation Site in Small Children

Abstract

Abstract Background We evaluated the posterior tibial artery as an alternative arterial cannulation site to the radial artery in small children. Methods A two-stage study was conducted. First, we evaluated the anatomical characteristics of the posterior tibial artery compared with the radial and dorsalis pedis arteries. Next, a parallel-arm single-blind randomized controlled study compared the initial success rate of ultrasound-guided arterial cannulation among three arteries as a primary outcome. Results Sixty patients were analyzed in the observational study. The diameter of the posterior tibial artery (1.5 ± 0.2 mm) was similar to that of the radial artery (1.5 ± 0.2 mm) and larger than that of the dorsalis pedis artery (1.2 ± 0.2 mm; P < 0.001). The posterior tibial artery has a larger cross-sectional area (2.8 ± 1.1 mm2) compared with the radial (2.3 ± 0.8 mm2; P = 0.013) and dorsalis pedis arteries (1.9 ± 0.6 mm2; P = 0.001). In total, 234 patients were analyzed in the randomized study. The first-attempt success rate of the posterior tibial artery (75%) was similar to that of the radial (83%; P = 0.129; odds ratio, 1.53; 95% CI, 0.69 to 3.37) and higher than that of the dorsalis pedis artery (45%; P < 0.001; odds ratio, 3.95; 95% CI, 1.99 to 7.87). Median cannulation time of the posterior tibial artery (21 s; interquartile range, 14 to 30) was similar to that of the radial artery (27 s; interquartile range, 17 to 37) and shorter than that of the dorsalis pedis artery (34 s; interquartile range, 21 to 50). Conclusions The posterior tibial artery is a reasonable alternative to the radial artery for ultrasound-guided arterial cannulation in small children.