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[Vascular injuries during percutaneous catheterization of the lower neck in children]
J Ricard1, J P Canarelli, J P Postel
1Service de Chirurgie Pédiatrique, CHU Amiens.
Insights
Vascular injuries to the subclavian artery in children can occur during percutaneous catheterization. Prompt diagnosis and preferred jugular access are crucial for managing these serious complications.
Area of Science:
- Pediatric Surgery
- Vascular Surgery
- Interventional Cardiology
Background:
- Percutaneous catheterization is a common procedure in pediatric medicine.
- Vascular injuries, though rare, are potential complications of these procedures.
- Subclavian artery injuries require prompt recognition and management.
Observation:
- Four cases of subclavian artery injury were identified in 414 pediatric percutaneous catheterizations.
- Injuries included aneurysm (treated with resection-anastomosis) and hemothorax.
- Diagnosis was often delayed, with hemothorax being the primary indicator.
Findings:
- Management varied from drainage alone to surgical repair (suture or ligation).
- Successful outcomes were achieved with appropriate interventions.
- The jugular approach was deemed safer than the subclavian approach in children.
Implications:
- Emphasizes the need for experienced operators and appropriate equipment in pediatric catheterization.
- Highlights the importance of early diagnosis and intervention for vascular lesions.
- Recommends prioritizing the jugular route to minimize subclavian artery injury risks.
Abstract:
Four cases of vascular injuries of subclavian artery in children are reported after 414 percutaneous catheterization between 1980 and 1986. The first case reported is a 2 month old child with a right subclavian aneurysm after punction, witch be treated by a successful resection-anastomosis. Three others children, 12, 13, and 14 years old have been catheterized by a jugular approach for one and by a subclavian approach in the others. In this three cases the diagnosis was made by an important hemothorax requiring a drainage. In one case, the recovery was obtain only by drainage, in the two others a surgical approach was necessary with a suture of the subclavian artery in one and a ligation in the other case. The diagnosis of these vascular lesion is difficult = an hemothorax must be drained quickly and a persistent bleeding require a surgical treatment by a cervical route associated with a cleidotomy for the subclavian control. All catheterization in children must be realized by operator with a good practice and an adapted material. The jugular route must be preferred to the subclavian route in children.