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Pseudoaneurysms of the brachial artery following venipuncture in infants
Ivo Dzepina1, Josip Unusic, Davor Mijatovic
1Department of Plastic and Reconstructive Surgery, Department of Surgery, University Hospital Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia.
Insights
Pediatric brachial artery pseudoaneurysms, a rare complication of infant venipuncture, require prompt diagnosis and microvascular repair. This study details three successful surgical reconstructions, highlighting early intervention for these challenging vascular injuries.
Area of Science:
- Vascular Surgery
- Pediatric Surgery
- Interventional Radiology
Background:
- Pediatric vascular injuries are rising due to increased survival of premature infants and invasive procedures.
- Brachial artery pseudoaneurysm in infants is an exceptionally rare complication of venipuncture.
Observation:
- This report details three infant cases of brachial artery pseudoaneurysm following venipuncture.
- Patients underwent surgery between 43-64 days old, with injury-to-operation times ranging from 25-42 days.
- Diagnosis was confirmed using duplex ultrasonography, with one case further evaluated by helical contrast computed tomography.
Findings:
- Two infants had pseudoaneurysms resected and underwent end-to-end anastomosis for arterial repair.
- One infant required a venous interposition graft for arterial reconstruction.
- All surgical interventions resulted in successful outcomes.
Implications:
- Brachial artery pseudoaneurysms, though rare, are a significant risk following infant venipuncture.
- Early diagnosis via advanced imaging is crucial for effective management.
- Microvascular reconstruction techniques are vital for successful treatment of these pediatric vascular injuries.
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.
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