ABSTRACT
Introduction Currently, many children undergo multiple cardiac catheterizations and surgical interventions early in their life, requiring intensive care admission and central line placement frequently involving the femoral vessels. As a result, these vessels may become occluded (Figure 9.1). In the presence of occluded femoral vessels alternate routes are sought to perform cardiac catheterization and/or intervention. The internal jugular approach or subclavian approach may be appropriate in some instances. In other instances where the patient has undergone cavo-pulmonary anastomosis it may be impossible to reach the area of interest using this approach. Additionally, it may be difficult to manipulate the catheters from that approach in certain areas of the heart and can be met with significant challenges.
