Ahmed Kayssi1, Furqan Shaikh2, Graham Roche-Nagle1, Barry Rubin1, Leonardo R. Brandao2, Suzan A. Williams2
1Division of Vascular Surgery, University Health Network, University of Toronto, Toronto, ON, Canada; 2Division of Haematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
OBJECTIVES: Acute limb ischemia (ALI) in pediatric patients is rare but may lead to limb loss and lifelong complications. The aim of this study was to review the experience of a Canadian tertiary pediatric center with the medical and operative management of ALI.
METHODS: The charts of in-patients diagnosed with acute upper or lower limb ischemia between 1999-2012 were reviewed. Patient demographics, arterial clot site and etiology, intervention, anticoagulation type and duration, and short and long-term complications were analyzed.
RESULTS: One hundred thirty-six patients presented with signs of limb ischemia (46% female, 34% younger than 30 days, 51% between 1-12 months, and 15% between 1-18 years). Ninety-five percent involved the lower limbs. Eighty-five percent of arterial clots were totally occlusive. Ninety-two percent were due to vessel catheterization, 5% were idiopathic and 2% were due to hereditary hypercoagulable states. Ninety-six percent were managed non-operatively. Patients were treated with a combination of thrombolysis, unfractionated or low molecular-weight heparin, aspirin and/or warfarin (duration 1 day to 13 years). All patients were followed post-discharge at our institution or at their referring hospital (average 3.5 years). Thirteen percent had complications related to ALI or anticoagulation (limb length or thigh circumference discrepancy, or intracranial hemorrhage). Twenty-five patients died of unrelated causes (sepsis, multi-organ dysfunction or cardiac failure).
CONCLUSIONS: In contrast with adults, ALI in children can generally be managed non-operatively with anticoagulation, likely because of their greater ability to develop arterial collaterals. Long-term follow-up by a multidisciplinary team of pediatric and surgical specialists and allied health professionals is integral to achieving a successful outcome.
AUTHOR DISCLOSURES: L. R. Brandao: Nothing to disclose; A. Kayssi: Nothing to disclose; G. Roche-Nagle: Nothing to disclose; B. Rubin: Nothing to disclose; F. Shaikh: Nothing to disclose; S. A. Williams: Nothing to disclose.
Post April 2013