Gow Kenneth W, Mykytenko James, Patrick Ellen L, Dodson Thomas F
Department of Surgery, Emory University, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
Am Surg. 2004 Jun;70(6):518-21.
Trauma to the wall of an artery may lead to the development of a pseudoaneurysm. There are infrequent case reports of children who have developed pseudoaneurysms after vascular access attempts. The options for management are limited in children and even more so in neonates. We describe the presentation and management of a 6-week-old infant who had attempts at insertion of an intravenous catheter as a newborn. She presented with an enlarging mass of the right upper extremity with no palpable radial pulse on examination. Workup included radiographs, Doppler ultrasound, and magnetic resonance imaging that established the diagnosis of pseudoaneurysm of the brachial artery. She underwent a repair of the right brachial artery by identifying the site of the arterial injury and oversewing the defect in the wall. Intraoperatively, she had good arterial flow with a return of the radial pulse. The patient did well immediately postoperatively and has been followed for more than a year with normal pulses and growth of the upper extremity. Patients that have had previous attempts at vascular access and subsequently develop a mass in the area of puncture should be worked up for the potential of a pseudoaneurysm. Doppler ultrasound and magnetic resonance imaging may help with diagnosis. Primary repair is advocated in this injury to ensure adequate growth of the limb.
动脉壁创伤可能导致假性动脉瘤的形成。有少数关于儿童在进行血管穿刺尝试后发生假性动脉瘤的病例报告。儿童假性动脉瘤的治疗选择有限，新生儿更是如此。我们描述了一名6周大婴儿的病例，该婴儿在新生儿期曾尝试插入静脉导管。她就诊时右上肢肿块逐渐增大，检查时未触及桡动脉搏动。检查包括X光片、多普勒超声和磁共振成像，确诊为肱动脉假性动脉瘤。通过确定动脉损伤部位并缝合血管壁缺损，对其进行了右肱动脉修复术。术中，她的动脉血流良好，桡动脉搏动恢复。患者术后即刻情况良好，随访一年多，脉搏正常，上肢生长正常。曾有过血管穿刺尝试且随后在穿刺部位出现肿块的患者，应检查是否存在假性动脉瘤的可能。多普勒超声和磁共振成像有助于诊断。对于这种损伤，主张进行一期修复以确保肢体充分生长。
