Iatrogenic Arterial Injuries in Neonates Secondary To Venepuncture – Presentation Management and Outcome
Keywords:
Arterial, iatrogenic, injury, neonates, venepunctureAbstract
Objective: To share collective operative experience in management of iatrogenic arterial injuries secondary to venepuncture in terms of demographics, clinical presentation, treatment and outcome; along with review of current relevant literature.
Materials & Methods: A prospective review of database at tertiary care military hospitals of all iatrogenic paediatric arterial injuries from March 2006 to March 2016 was performed. The data was analysed in terms of demographics, presentation, treatment and outcome.
Results: A total of 28 patients were referred from various hospitals with iatrogenic arterial injuries during venepuncture. The mean age was 13 ± SD 4 days and weight was 2.6 ± SD 0.8 Kgs. Of the 28; 71.4% (n=20) had acute limb ischemia (ALI), 21.4% (n=6) dry gangrene and 7.1% (n=2) had pseudo-aneurysm. All patients with ALI underwent thrombo-embolectomy, amputations were done for dry gangrene and pseudo-aneurysms were resected with reverse venous bypass grafting. Mean follow up of 12 months was uneventful.
Conclusion: Iatrogenic neonatal arterial injuries secondary to venepuncture are rare but may cause limb and even life threatening complications. Early diagnosis and surgical intervention using microsurgical techniques is limb saving and prevents long term complications.
Downloads
References
De Virgilio C, Mercado D, Arnell T, et al. Noniatrogenic pediatric vascular trauma:a ten-year experience at a Level
I trauma center.Ann Surg 1997;63:781-4.
Lin H, Dodson F, Bush L: Surgical intervention for complications caused by femoral artery catherization in pediatric patients. J Vasc Surg. 2001;34:1071-8.
Giaquinta A, Veroux M, Virgilio C, Cannizzaro A, Zerbo D, Leonardi A et al. Brachial thrombosis in a premature neonate. Ann Ital Chir. 2012;83:149-51.
Andraska A, Jackson T, Chen H, Gallagher A, Eliason L, Coleman M. Natural History of Iatrogenic Pediatric
Femoral Artery Injury. Ann Vasc Surg. 2017 Mar 22. pii: S0890-5096:30433-8.
Wisecup S, Eades S, Turiy Y. Characterizing the Risk Factors Associated With Venous Thromboembolism in Pediatric Patients After Central Venous Line Placement. J Pediatr Pharmacol Ther. 2015;20:358-66.
O'Neill A, Neblett W, Born L. Management of major thromboembolic complications of umbilical artery catheters. J Paed Surg. 1981;16:972-8.
Gamba P, Tchaprassian Z, Verlato F, Verlato G, Orzali A, Zanon GF. Iatrogenic vascular lesions in extremely low birth weight and low birth weight neonates. J Vasc Surg. 1997;26:643-6.
Giswold E, Landry J, Taylor M, Moneta L. Iatrogenic arterial injury is an increasingly important cause of arterial trauma. Am J Surg. 2004;187:590-3.
Gault T. Vascular compromise in newborn infants. Arch Disc Child. 1992;67:463-7.
Flanigan P, Keifer J, Schuler J, Ryan J, Castronuovo J. Experience with latrogenic pediatric vascular injuries.
Incidence, etiology, management, and results. Ann Surg. 1983;198:430.
Aspalter M, Domenig M, Haumer M, Kitzmuller E, Kretschmer G,Holzenbein J.Management of iatrogenic common femoral artery injuries in pediatric patients using primary vein patch angioplasty. J Ped Surg.2007;42:1898-902.
Maleux G,Herten J,Vaninbroukx J,Thijs M, Nijs S, Fourneau I. Value of percutaneous embolotherapy for the management of traumatic vascular limb injury.Acta Radial. 2012. 53:147-52.
Monagle P, Chan K, Goldenberg A, Ichord N,Journeycake M, Nowak-Gottl U et al. Antithrombotic therapy in neonates and children: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines.
Chest. 2012;141 Suppl)e737S-801S.
Kirkilas M, Notrica M, Langlais S, Muenzer T, Zoldos J, Graziano K. Outcomes of arterial vascular extremity trauma in pediatric patients. J Pediatr Surg. 2016;51:188.
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Rashid Usman, Muhammad Jamil, Khalid Mehmood
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Articles published in the Journal of Dow University of Health Sciences are distributed under the terms of the Creative Commons Attribution Non-Commercial License https://creativecommons.org/ licenses/by-nc/4.0/. This license permits use, distribution and reproduction in any medium; provided the original work is properly cited and initial publication in this journal.