Pseudoaneurysms of the brachial artery following venipuncture in infants

Abstract

Pediatric vascular injuries are increasing in frequency and represent a challenging problem in pediatric surgical practice. Increased survival of low birth weight infants and advances in invasive diagnostic procedures have resulted in a dramatic increase in the number of these injuries. Formation of pseudoaneurysm of the brachial artery in infants is a very rare complication of venipuncture, with only two cases reported in the literature. We report three cases of brachial artery pseudoaneurysm in infants following venipuncture who were operated upon in our institution, aged 43-64 days at the time of operation. The period from the injury to the operation ranged from 25 to 42 days. All three infants were referred from different institutions. In two infants, the pseudoaneurysms and the involved part of the artery were resected, and arterial continuity was restored with an end-to-end anastomosis; in the other infant, reconstruction was done using a venous interposition graft. All three infants were diagnosed with duplex ultrasonography, and the child requiring a more complex reconstructive procedure was also evaluated with helical contrast computed tomography. Brachial artery pseudoaneurysms are a rare but possible complication of multiple venipuncture in infants. Early diagnosis and microvascular reconstruction are key points in managing these injuries.

Pseudoaneurysm formation following a traumatic wrist laceration

“…8 There are no data to suggest that the incidence of pseudoaneuryms is epidemiologically skewed based on age. In contrast to adults, however, vascular injuries in children pose unique problems such as the possible complications of tissue loss and growth discrepancy secondary to arterial ischemia and arteriovenous fistulae.…”

“…In contrast to adults, however, vascular injuries in children pose unique problems such as the possible complications of tissue loss and growth discrepancy secondary to arterial ischemia and arteriovenous fistulae. 8 Many of these lesions occur as a result of missed injury at the time of presentation. They have been reported to present months to years after the initial injury.…”

Value of computed tomographic angiography in neck and extremity pediatric vascular trauma

“…CTA had 90% accuracy, 86% sensitivity, 100% specificity, 100% positive predictive value, and 74% negative predictive value in the diagnosis of hepatic artery thrombosis or stenosis and portal vein stenosis or occlusion in patients with findings suggestive of biliary or vascular compromise status postliver transplantation [29]. Furthermore, the surgical repair of pediatric brachial artery pseudoaneurysms after catheterizations have been planned with the assistance of CTA instead of CA [30]. The 95% to 100% sensitivity and 90% to 98% specificity achieved by CA in the diagnosis of vascular trauma [3,4] is comparable to the sensitivity and specificity achieved by CTA in this study.…”

Computed tomographic angiography in pediatric blunt traumatic vascular injury

“…Recently, the 64-slice computed tomographic (CT) scanner has been shown to be as effective as angiography in evaluating congenital heart disease by demonstrating the major vascular structures and the proximal right and left coronary arteries [22]. Computed tomographic angiography has also been used instead of contrast angiography for surgical planning in repair of pediatric brachial artery pseudoaneurysms after catheterizations [23].…”