S. Wang1, A. R. Gutwein1, N. A. Drucker1, R. L. Motaganahalli1, M. C. Dalsing1, B. W. Gray1, M. P. Murphy1, G. W. Lemmon1 1Indiana University School Of Medicine,Indianapolis, IN, USA
Objective:
Acute limb ischemia (ALI) in infants poses a challenge to the clinician secondary to poor operative outcomes, limb loss risk, and life-long morbidity. This retrospective study reviews a 10-year institutional experience with non-operative management of ALI in infants.
Methods:
Infants (age ≤ 12-months) diagnosed with ALI by duplex and treated with initial non-operative management at a tertiary care dedicated children’s hospital were identified via vascular laboratory lower extremity arterial duplex records. Patient demographics, injury characteristics, treatment given, and outcomes were abstracted via chart review and presented using descriptive statistics. Continuous variables are presented as mean ± standard deviation.
Results:
During the study period, a total of 25 (28% female) infant patients were diagnosed with ALI. The average age for this cohort was 3.5 ± 3.2 months. The majority of cases were secondary to iatrogenic injury (88%) from arterial cannulation (Table). Injury sites were concentrated to the lower extremities (84%) as compared to the upper. Absence of Doppler signals were noted in 64% of infants while limb cyanosis observed in 60% at the time of presentation.
Infants were initially treated with anticoagulation (80%) when possible. Two patients failed non-operative management and required thrombolysis secondary to progression of thrombus burden while anticoagulated. There were no major (above-ankle) amputations at 30-days. Three deaths occurred within 30-days; all were unrelated to limb ischemia. In the 30-day survivors, overall duration of follow-up was 52.1 ± 37.7 months. One infant required above-knee amputation six weeks after diagnosis resulting in an overall limb salvage rate of 96%. Long-term morbidity included two patients with a chronic wound of the affected limb and one patient with limb length discrepancy. No subjects reported claudication at the latest follow-up appointment. Additionally, all patients were independently ambulatory except for one female who was using a walker with leg braces.
Conclusions:
In contrast to the adult population, ALI in infants can be managed with anticoagulation and non-operative intervention. Long-term follow-up continues to demonstrate excellent functional results and minimal disability.
