Iatrogenic Brachial and Femoral Artery Complications Following Venipuncture in Children
Introduction. Catheter- or noncatheter-related peripheral arterial complications such as arterial pseudoaneurysm, embolus, or arteriovenous fistula may be seen in the pediatric age group. The most common etiologies defined for arterial complications are peripheral arterial puncture performed for a routine arterial blood gas analysis, arterial catheters placed for invasive monitorization of children, or catheterization performed for diagnostic purposes through the peripheral arterial system, most commonly the femoral artery.
Materials and Methods. Nine children with peripheral arterial complications, whose ages varied between 2 months and 2.5 years, were enrolled in this study. All patients were treated surgically. Following physical examination, Doppler ultrasonography, computed tomography angiography, magnetic resonance angiography, or digital subtraction angiography were used as diagnostic tools. We studied thrombophilic panels preoperatively. Six patients had brachial artery pseudoaneurysms that developed accidentally during venipuncture, I had a brachial arteriovenous fistula that developed after an accidental brachial artery puncture during routine peripheral blood analysis. In the remaining 2 patients, peripheral arterial embolic events were detected. One had a left brachial arterial embolus and the other had a sudden onset right femoral artery embolus that was detected via diagnostic interventions.
Results. No morbidity such as amputation, extremity loss, or mortality occurred due to the arterial events or surgery. All patients were discharged from the hospital in good clinical condition. In all patients, follow-up at 3 or 6 months revealed palpable peripheral artery pulsations of the ulnar and radial arteries at wrist level.
Conclusion. Because the incidence of peripheral arterial complications is relatively low in children compared to adults, the diagnostic and therapeutic approaches are extrapolated from the adult guidelines. We proposed that early diagnosis and surgical approach prevented the complications from further developing in the affected extremity in these particular cases.
Jutte EH, Wisselink AR, Rauwerda JA. 2002. Pseudoaneurysm of the brachial artery due to blunt trauma. Cardiovasc Surg 101:52-3.nKlein MD, Coran AG, Whitehouse WM, Stanley JC, Wesley JR, Lebowitz EA. 1982. Management of iatrogenic arterial injuries in infants and children. J Pediatr Surg 17:933-9.nLennox A, Griffin M, Nicolaides A, et al. 1998. Regarding percutaneous ultrasound guided thrombin injection: a new method for treating postcatheterization femoral pseudoaneurysms. J Vase Surg 27:1032-8.nMorrison WG. 1992. Pseudoaneurysm and penetrating trauma. Injury 23:127-8.nIno T, Yazawa K, Kawamura S, Takeoka M, Yashiro N. 2001. Secondary arteriovenous fistula after a single arterial puncture. Pediatr Int 43:179-80.nDemircin M, Peker O, Tok M, Ozen H. 1996. False aneurysm of the brachial artery in an infant following attempted venipuncture. Turk J Pediatr 38:389-91.nDzepina I, Unusic J, Mijatovic D, Bulic K. 2004. Pseudoaneurysms of the brachial artery following venipuncture in infants. Pediatr Surg Int 20:594-7.nBrophy DP, Sheimen RG, Amatulle P, et al. 2000. Iatrogenic femoral pseudoaneurysms: thrombin injection after failed US guided compression. Radiology 214:278-82.nCoen LD, Johnson BF, Moorhead PJ, Raftery AT. 1990. False aneurysm of the brachial artery: an unusual complication following accidental puncture by a patient on home haemodialysis. Br J Clin Pract 44:2002-3.nCriado E. 1997. Endovascular repair of peripheral aneurysm, pseudoaneurysm, and arteriovenous fistulas. Ann Vasc Surg 11:256-63.nThalhammer C, Kirchherr AS, Uchlich F, et al. 2000. Postcatheterization pseudoaneurysms and arteriovenous fistulas: repair with percutaneous implantation of endovascular covered stents. Radiology 214:127-31.nWhite JJ, Talbert JL, Haller JA. 1968. Peripheral arterial injuries in infants and children. Ann Surg 167:757-66.nYetman RJ, Black CT. 1992. Traumatic false aneurysms of peripheral arteries in children. South Med J 85:665-6.nNorcross WA, Shackford SR. 1988. Arteriovenous fistula: a potential complication of venipuncture. Arc Intern Med 148:1815-6.nRey C, Marache P, Watel A, Francart C. 1987. Iatrogenic false aneurysm of the brachial artery in an infant. Eur J Pediatr 146:438-9.n
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).