Acute Limb Ischemia in Pediatric Population Secondary to Peripheral Vascular Cannulation: Literature Review and Recommendations.
BACKGROUND
In this article, we discuss published literature on the management of pediatric patients with acute limb ischemia and also present our center's experience.


RESULTS
Literature review suggests that in the absence of imminent risk of limb loss, noninterventional management with anticoagulants and systemic thrombolysis is preferable and associated with better clinical outcomes than surgery such as reduced per operative morbidity and mortality. In selected more severe cases, surgery may be required. We propose an algorithm for improved clinical outcomes based on the published literature and the American College of Chest Physicians' recommendations for antithrombotic management in the pediatric population.


CONCLUSIONS
Literature review suggests an inverse relationship between age and surgical success, particularly in preschool pediatric population. Conservative management as a preliminary strategy seems most beneficial. It is hoped that the proposed intercalated algorithm of medical and surgical management of these patients can further improve clinical outcomes.
Cambridge Vascular Unit, Addenbrooke's Hospital, Cambridge University hospitals NHS Foundation Trust, Cambridge, United Kingdom sadat.umar@gmail.com.
Umar
U
Sadat
Cambridge Vascular Unit, Addenbrooke's Hospital, Cambridge University hospitals NHS Foundation Trust, Cambridge, United Kingdom.
Paul D
PD
Hayes
Cambridge Vascular Unit, Addenbrooke's Hospital, Cambridge University hospitals NHS Foundation Trust, Cambridge, United Kingdom.
Kevin
K
Varty
D000208:Acute Disease; D000293:Adolescent; D000367:Age Factors; D000465:Algorithms; D000925:Anticoagulants / Q000627:therapeutic use; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D019091:Critical Pathways; D005121:Extremities / Q000098:blood supply*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D023821:Limb Salvage; D018579:Patient Selection; D012307:Risk Factors; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy
D000925:Anticoagulants
artery; cannulation; catheterization; ischemia; pediatric; thromboembolism; thrombosis; vein