Management of acute limb ischemia in the pediatric population

• Published in: Journal of vascular surgery Vol. 60; no. 1; pp. 106 - 110
• Main Authors: Kayssi, Ahmed, MD, MS, Shaikh, Furqan, MD, MS, Roche-Nagle, Graham, MD, MBA, Brandao, Leonardo R., MD, MS, Williams, Suzan A., MD, Rubin, Barry B., MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.07.2014
• Subjects: Acute Disease; Adolescent; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Aspirin - therapeutic use; Canada; Catheterization, Peripheral - adverse effects; Child; Child, Preschool; Female; Fibrinolytic Agents - therapeutic use; Heparin, Low-Molecular-Weight - therapeutic use; Hospitals, Pediatric; Humans; Infant; Intracranial Hemorrhages - chemically induced; Ischemia - complications; Ischemia - therapy; Lower Extremity - blood supply; Lower Extremity - injuries; Male; Organ Size; Retrospective Studies; Surgery; Tertiary Care Centers; Upper Extremity - blood supply; Upper Extremity - injuries; Warfarin - therapeutic use; Canada
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2014.01.051

Objective Acute limb ischemia (ALI) in pediatric patients is rare but may lead to limb loss and life-long complications. This study reviewed the experience of a Canadian tertiary pediatric center with the medical and operative management of ALI. Methods The medical records of inpatients diagnosed with ALI of the upper or lower limb between 1999 and 2012 were reviewed. Patient demographics, arterial clot site and etiology, intervention, anticoagulation type and duration, and short-term and long-term complications were analyzed. Results A total of 151 patients (45% female) presented with signs of limb ischemia, of whom 38% were aged <30 days, 46% were between 1 and 12 months, and 16% were between 1 and 18 years. Ninety-four percent of those injuries involved the lower limbs. Ninety-one percent were due to vessel catheterization, 5% were idiopathic, 1% were congenital, and 4% traumatic. Ninety-four percent were managed nonoperatively. Patients were treated with a combination of thrombolysis, unfractionated or low-molecular-weight heparin, aspirin or warfarin, or both (duration, 1 day-13 years). All patients were monitored after discharge at our institution or at their referring hospital (average, 3.4 ± 2.8 years). Fifteen percent had complications related to ALI or anticoagulation (most commonly limb length or thigh circumference discrepancy, or intracranial hemorrhage). Nineteen percent of patients died of unrelated causes (sepsis, multiorgan dysfunction, or cardiac failure). Conclusions In contrast with adults, ALI in children can generally be managed nonoperatively with anticoagulation, likely because of their greater ability to develop arterial collaterals. Long-term follow-up by a multidisciplinary team of pediatric and surgical specialists and allied health professionals is integral to achieving a successful outcome in children with ALI.