Iatrogenic lower limb ischemia in children with congenital cardiac disease

Abstract

Aim: To report our experience of the management of peripheral artery cannulation-induced limb ischemia in neonates, infants, and children (<5 years). Materials and Methods: Children <5 years old with peripheral ischemia who had undergone cardiac surgery or intervention who were referred to the vascular surgery service from March 2013 to June 2014 were included prospectively. All patients were assessed at referral and during follow-up clinically and with arterial duplex imaging. Follow-up included clinical review and arterial duplex at 1 week and clinical follow-up thereafter. Results: Twenty-six children (14 males, 12 females) with a median age of 21 months were assessed. This included three neonates with a median age of 10 days (range 3–26) and 12 infants with a median age of 5.5 months (range 3–11 months). Referral to the vascular service was initiated on the basis of a combination of absent pulses (46.2%), pregangrenous changes (34.6%), and cold limbs (19.2%). Thirteen (50%) patients had limb ischemia postarterial line insertion, while all other patients presented with limb ischemia postarterial sheath insertion. Median duration for limb ischemia postarterial line was 6 days while it was 3 h for sheath. All patients were treated with intravenous heparin infusion, antiplatelet, and supportive care. No patient required any surgical intervention. On mean follow-up of 11 months, no patient had any complication or limb loss or any further progression of pregangrene. Out of 26, five patients (19.2%) died, four due to underlying cardiac disease, and one due to septicemia, which were not directly related to limb ischemia. Conclusion: In our experience, anticoagulation, antiplatelets, and supportive care are very effective in the management of iatrogenic femoral artery-associated ischemia in young children, infants, and neonates.

Keywords

• Congenital cardiac disease
• iatrogenic
• limb ischemia
• pediatric