Microvascular reconstruction of major arteries in neonates and small children

Arterial injuries in neonates and children under 2 years of age, although relatively uncommon, should be treated by prompt exploration and reconstruction using microvascular techniques. In the past, a reluctant attitude has prevailed in cases involving neonates or infants because of small vessel caliber and the problem of spasm. We reviewed our experience with 9 nonreplantation, arterial reconstructions in children under 2 years of age. The most frequent age at reconstruction was 1.0 month and extended from the immediate newborn period to 24 months of age. All patients were at risk for tissue necrosis. Eight children sustained iatrogenic injuries related either to invasive catheter manipulation (n = 6) or operative transection (n = 2). The ninth patient required reconstruction of the subclavian artery sacrificed during excision of a malignant tumor. There were 5 femoral, 1 subclavian, 1 brachial, 1 posterior tibial, and 1 radial artery repairs. Direct arterial repair was accomplished in one patient with a brachial artery thrombus and another with a transected superficial femoral artery. Reversed saphenous vein grafts were used in the remaining patients. Iatrogenic dissection of the ipsilateral iliac artery necessitated use of a femofemoral bypass graft to achieve adequate inflow in one newborn. There were no operative deaths, no reexplorations, and normal perfusion was restored to all involved extremities. We conclude that microvascular technique allows early, successful arterial reconstruction and limb salvage in neonates and small children.