Brachial artery thrombosis in infants: an algorithm for limb salvage

Plastic and Reconstructive Surgery
Christopher J CoombsPaul Monagle

Abstract

Arterial occlusion in infants, although uncommon, is usually an iatrogenic event associated with arterial vascular access. Most common in the upper limb, the consequences of iatrogenic arterial occlusion may be gangrene and limb loss. Even if there is adequate collateral flow and limb loss is avoided, long-term growth disturbances may be seen. There are few published data to guide the management of arterial occlusion in premature or sick infants. In general, there is agreement regarding the importance of early diagnosis and the reestablishment of limb perfusion with the fewest risks, but the optimal choice and timing of treatment modalities remain unknown. This article examines the authors' experiences at the Royal Children's Hospital, Melbourne, and provides their algorithm for the management of this complex iatrogenic disease. The management algorithm has successfully treated 11 limbs in 11 patients with arterial vascular access-associated thrombosis over the period 1995 to 2003, with no instances of limb loss. Five of these patients required surgical intervention. The authors recommend a multidisciplinary approach involving plastic surgeons and hematologists for all cases of suspected or confirmed arterial thrombosis. A cons...Continue Reading

References

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Citations

Nov 13, 2012·Plastic and Reconstructive Surgery·Cara DowneyJeffrey D Friedman
Nov 20, 2013·Journal of Clinical Neonatology·Jiber HamidBouarhroum Abdellatif
Nov 11, 2015·Seminars in Fetal & Neonatal Medicine·Revathi RajagopalPaul Monagle
Feb 22, 2012·Clinics in Perinatology·Matthew A Saxonhouse
Jul 29, 2010·Blood Reviews·Paul MonagleJanine Campbell
Mar 20, 2010·Chirurgie de la main·P W H DakouréT Kambou
Jan 27, 2009·Seminars in Perinatology·Matthew A Saxonhouse, Marilyn J Manco-Johnson
Oct 18, 2008·Journal of Pediatric Surgery·Niyi Ade-AjayiDavid P Drake
Oct 8, 2009·British Journal of Haematology·Michael D Williams
Aug 8, 2015·Clinics in Perinatology·Matthew A Saxonhouse
Feb 19, 2008·Clinics in Perinatology·Jayashree Ramasethu
Jan 16, 2013·Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS·Georgios Orfaniotis, Stuart B Watson
Mar 13, 2009·Journal of Perinatology : Official Journal of the California Perinatal Association·M A Saxonhouse, D J Burchfield

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