Elsevier

Annals of Vascular Surgery

Volume 42, July 2017, Pages 205-213
Annals of Vascular Surgery

Clinical Research
Natural History of Iatrogenic Pediatric Femoral Artery Injury

Presented at the Winter Meeting of the Vascular and Endovascular Surgical Society, February 2015.
https://doi.org/10.1016/j.avsg.2016.11.016Get rights and content

Background

Iatrogenic femoral artery trauma complicates the course of critically ill neonates and children. Complications from persistent arterial occlusion may include claudication and limb length discrepancies. Data supporting risk factors for such and need for revascularization are lacking.

Methods

Review of a prospectively maintained database at a tertiary institution of iatrogenic pediatric femoral artery injuries incurred between 2013 and 2014 was performed. Additional injuries were identified by review of pediatric arterial duplex performed between 2008 and 2013. Demographics, risk factors, and outcomes were queried. Data analysis utilized Fischer's exact t-test and logistic regression.

Results

Seventy-six patients were identified of which 68 presented with acute limb ischemia (ALI) and 8 with chronic iliofemoral arterial occlusion resulting in claudication (n = 6) or limb length discrepancy (n = 2). Mean weight at injury was 6.3 kg; mean age at injury was 49 weeks (50% aged <3 months). Mean follow-up was 14 months (out to 11 years). Six patients required surgery for ALI, and 6 required delayed operation for limb length discrepancy (n = 4) or for persistent external iliac artery (EIA) occlusion. Mean age at delayed revascularization was 6 years (range: 2–13 years). Vasopressor use, mechanism/location of injury, and concomitant venous thrombosis were not significantly correlated with need for operation; trends suggested that cardiac catheterization and EIA thrombosis may correlate with chronic disease. Increased age at injury was associated with need for operation.

Conclusions

Although a majority of children with ALI may be successfully treated medically, 9% will require operation for ALI and 16% ultimately required revascularization during follow-up. Persistent iliofemoral arterial thrombosis is a likely risk factor for limb length discrepancy with growth; identifying risk factors for this and improved methods for surveillance requires ongoing investigation.

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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