¼ 20) or arterial line placement (n ¼ 60). Mean age at time of injury was 3.79 months (65.43 months), and mean weight at time of injury was 4.54 kg (62.24 kg). All patients were treated with therapeutic anticoagulation, typically for 6 weeks, with early ultrasound repeated before cessation of such. Early and complete femoral thrombus resolution, as confirmed by ultrasound, was identified in most patients (86.25%; n ¼ 69) within an average of 5.02 weeks (63.58 weeks; Fig). Only 8.75% (n ¼ 7) demonstrated persistent femoral artery thrombus by ultrasound at early follow-up. Whereas four children ultimately achieved femoral artery thrombus resolution during interim follow-up (mean, 8.33 6 6.80 months), all had persistent asymmetric duplex ultrasound features at last followup and have continued surveillance, with four subsequently developing LLD. Of those without visible thrombus by duplex ultrasound at early follow-up, asymmetric duplex ultrasound features were identified and persistent in 12 patients (17%), 1 of whom has developed progressive LLD. Mean LLD was 6.29 mm (62.5 mm), typically diagnosed 2 years (617.24 years) after injury, and no child to date has required surgical revascularization.Conclusions: The majority of pediatric ALI after iatrogenic line-associated femoral injury may be successfully managed with therapeutic anticoagulation. Infants have a unique ability to thrombolyse and fully resolve acute femoral arterial thrombus with anticoagulation alone. Occult proximal external iliac artery occlusion may be present, despite ultrasound reports of thrombus resolution. Those patients with asymmetric duplex ultrasound features warrant ongoing surveillance with annual physical examination that considers limb length.
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