Natural History of Iatrogenic Pediatric Femoral Artery Injury.
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 of Vascular Surgery, University of Michigan Cardiovascular Center, Ann Arbor, MI.
Elizabeth A
EA
Andraska
Section of Vascular Surgery, University of Michigan Cardiovascular Center, Ann Arbor, MI.
Tatum
T
Jackson
Section of Vascular Surgery, University of Michigan Cardiovascular Center, Ann Arbor, MI.
Huiting
H
Chen
Section of Vascular Surgery, University of Michigan Cardiovascular Center, Ann Arbor, MI.
Katherine A
KA
Gallagher
Section of Vascular Surgery, University of Michigan Cardiovascular Center, Ann Arbor, MI.
Jonathan L
JL
Eliason
Section of Vascular Surgery, University of Michigan Cardiovascular Center, Ann Arbor, MI. Electronic address: dawnbarn@umich.edu.
Dawn M
DM
Coleman
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D006801:Humans; D007049:Iatrogenic Disease; D007223:Infant; D007231:Infant, Newborn; D007383:Intermittent Claudication / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D007870:Leg Length Inequality / Q000209:etiology; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*