Jonathan L. Eliason, Adam Gumushian, Dawn M. Coleman, James C. Stanley
Section of Vascular Surgery, University of Michigan, Ann Arbor, MI.
OBJECTIVES: Arterial reconstructions requiring bypass for extremity disease in pediatric patients are uncommon. The intent of this study is to define differences between upper and lower extremity reconstructions in regard to: reasons for treatment and long-term outcomes.
METHODS: Upper extremity bypasses were performed in 10 children, 6 months to 12 years in age (mean 7.1 years), for: penetrating (2) and blunt (5) trauma, as well as for asymptomatic aneurysms (3). Lower extremity bypasses were performed in 28 children, 2 months to 10 years in age (mean 5.5 years), for: non-acute catheter-related (23) or idiopathic (2) occlusions, non-iatrogenic trauma (2) and aneurysm (1).
RESULTS: All upper extremity bypasses were constructed with autogenous saphenous vein as interposition brachial (8) or axillary (1) artery grafts, and an axillobrachial arterial graft (1). Upper extremity bypass follow-up averaged 4.1 years with sustained patency and no evidence of graft deterioration. All but one of the lower extremity bypasses were constructed with autogenous vein; the single exception utilized PTFE when no suitable vein existed. Bypasses involved the iliofemoral (23) and femoropopliteal (5) arteries. Grafts traversing the abdominal cavity were preferentially covered with a Dacron mesh to limit later aneurysmal changes. Follow-up of lower extremity reconstructions averaged 10.3 years. Five major complications occurred, including: late vein graft occlusions (4) and aneurysmal vein graft deterioration (1). Symptomatic ischemia in 14 patients resolved in all but one child, and preoperative limb-length discrepancies in 17 children ceased to be progressive. No major perioperative complications or operative mortality occurred in this experience.
CONCLUSIONS: Upper and lower extremity arterial bypasses with autogenous saphenous vein may be performed successfully in preadolescent children. Lower extremity reconstructions warrant careful long-term follow-up given the potential for late graft occlusion and aneurysmal changes.
AUTHOR DISCLOSURES: D. M. Coleman: Nothing to disclose; J. L. Eliason: Nothing to disclose; A. Gumushian: Nothing to disclose; J. C. Stanley: Nothing to disclose.
Posted April 2013