Microvascular and thrombolytic revascularization of an arm in a 32-week-gestation neonate: case report and review of the literature.
A 2300-g pre-term neonate with severe hyaline membrane disease experienced right forearm and hand ischemia following a brachial arterial line insertion. Limb salvage was achieved through combined microsurgical exploration and thrombectomy of the brachial and radial arteries, with postoperative regional infusion of tissue plasminogen activator (TPA) through the distal radial artery for 48 hr, to dissolve a thrombus within the small vessels of the hand. This report advocates combined surgical and regional thrombolytic therapy with tissue plasminogen activator as management for neonatal arterial thrombosis and limb ischemia.
Theile
R J
RJ
Department of Plastic and Maxillofacial Surgery, Royal Children's Hospital, Melbourne, Australia.
Coombs
C J
CJ
D001132:Arm / Q000098:blood supply*; D001916:Brachial Artery / Q000293:injuries / Q000601:surgery; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D006801:Humans; D006819:Hyaline Membrane Disease / Q000628:therapy; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000628:therapy*; D007511:Ischemia / Q000209:etiology / Q000628:therapy*; D008297:Male; D010960:Plasminogen Activators / Q000627:therapeutic use*; D017534:Radial Artery / Q000601:surgery; D017131:Thrombectomy; D013927:Thrombosis / Q000209:etiology / Q000628:therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator