Infant acute limb ischaemia should be treated non-operatively


Infants with acute limb ischaemia should be treated conservatively with observation and anticoagulation, and intervention should be performed only in cases presenting tissue loss, a study has recommended.

Results of a retrospective analysis were presented at the Society for Vascular Surgery Annual Meeting in Chicago, USA.


“Acute limb ischaemia in infants is a catastrophic event usually associated with other life threatening medical problems,” said Jesus M Matos, Indiana University School of Medicine, Indianapolis, USA. “Since acute limb ischaemia is rare in the infant population it presents a clinical conundrum for the vascular surgeon with regards to management.”


Matos presented his centre’s experience in the management of infant acute limb ischaemia, with retrospective data of the centre’s vascular surgery database from 2004–2010 of infants diagnosed with the condition.


Twelve infants with a mean age of 3±3 months were identified. There were 11 iatrogenic injuries and one unknown cause of acute limb ischaemia. The most frequent presentations were cyanotic limbs (n=8) and pulselessness (n=6). The lower extremities were most commonly involved (n=9). The most common arterial sites of occlusion were the common femoral artery (n=6), superficial femoral artery (n=3), and radial arteries (n=2). Eleven patients were treated conservatively with systemic heparin (n=9), intramuscular enoxaparin (n=2). One patient was treated surgically with a Fogarty balloon thrombectomy of the common femoral artery.


“There were three deaths all due to associated comorbidities. The one surgically managed patient died 30 days after intervention due to septic complications,” Matos said.


Follow-up was available on seven of nine survivors. All had palpable pulses present and viable limbs on follow-up examination (mean 20±14 months, range 5–42). There were three complications in the patients managed conservatively: loss of fingernails (1), skin necrosis requiring debridement (1), and maldevelopment of the foot (1). None of the patients required amputation due to conservative management.


“Limb viability was 100% in this series of infant acute limb ischaemia managed non-operatively, which reflects the potential of collateral vessel formation and recanalisation of thrombosed vessels in this patient population,” Matos said. “Diagnosis should be performed with physical examination and ultrasound. Our recommendation for infants presenting with acute limb ischaemia is conservative observation with anticoagulation and intervention only for cases with tissue loss,” he concluded.