Clinical ResearchNatural History of Iatrogenic Pediatric Femoral Artery Injury
Section snippets
Background
Iatrogenic femoral artery trauma complicates the course of critically ill neonates and children. Arterial cannulation is a leading cause of acute arterial thrombosis and ischemia, and it has been suggested that femoral artery catheterization in children may be complicated by a 2% risk of arterial injury.1 Acute injury and ischemia can often be managed successfully nonoperatively, although complications from persistent arterial occlusion include claudication and limb length discrepancies, which
Methods
A retrospective review of all lower extremity arterial duplex studies performed at the University of Michigan on children ≤17 years of age between January 2008 to May 2013 (n = 161) was performed. This query identified 59 cases of iatrogenic femoral artery injury that resulted in either acute ischemia or chronic iliofemoral arterial occlusion. Additional review of a prospectively maintained database at of iatrogenic pediatric femoral artery injuries incurred between 2013 and 2014 was performed
Results
In total, 81 patients were identified with iatrogenic femoral artery trauma of which 91% (n = 74) presented with acute limb ischemia (ALI) and the remaining 7 patients with chronic iliofemoral arterial occlusion. Demographics and risk factors are summarized in Table I. Patients with ALI by definition presented with acute inpatient symptoms at the time of femoral artery cannulation with arterial injury documented with duplex imaging. These patients with ALI averaged 1.4 years of age (range:
Discussion
This contemporary pediatric experience outlines the spectrum of complications that can result from iatrogenic injury to the femoral artery in both acute and chronic settings. It has been previously shown that most pediatric lower extremity ischemia results from iatrogenic trauma, most commonly arterial catheterization which is estimated to complicate approximately 2% of femoral artery catheterizations.1, 2, 5, 6, 7, 8, 9 Immediate anticoagulation remains the mainstay of care after suspected
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