Conservative Approach is Safe for Perfused-Pulseless Hands Following Blunt Brachial Artery Injury in Children

Area of Science:

• Vascular Surgery
• Pediatric Trauma Care
• Diagnostic Imaging

Background:

• Blunt brachial artery (BA) trauma in children often accompanies other injuries.
• Management of warm-pulseless hands post-elbow trauma is debated.
• Conservative treatment for non-limb-threatening BA injuries requires evaluation.

Purpose of the Study:

• To assess the efficacy and safety of conservative management for pediatric blunt BA injuries.
• To determine outcomes in children with warm-pulseless hands following blunt BA trauma.
• To evaluate the role of duplex ultrasound in monitoring BA injury outcomes.

Main Methods:

• Retrospective study of eleven pediatric patients with blunt BA trauma and warm-pulseless hands.
• Clinical examination and duplex ultrasonography performed at a mean follow-up of 2.5 years.
• Comparison of peak systolic velocity between affected and contralateral wrists.

Main Results:

• All patients achieved well-perfused hands with palpable wrist pulses post-treatment.
• Duplex scans confirmed graft patency in those who underwent interposition grafting.
• No significant difference in wrist peak systolic velocity between affected and healthy forearms (p=0.14).

Conclusions:

• Conservative treatment is a safe initial approach for pediatric blunt BA trauma with warm-pulseless hands.
• Surgical intervention should be considered only if pulses do not recover within 48 hours.
• Duplex ultrasound is valuable for assessing surgical repair patency and long-term surveillance.