Kayssi Ahmed, Shaikh Furqan, Roche-Nagle Graham, Brandao Leonardo R, Williams Suzan A, Rubin Barry B
Division of Vascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Division of Haematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
J Vasc Surg. 2014 Jul;60(1):106-10. doi: 10.1016/j.jvs.2014.01.051. Epub 2014 Mar 20.
Acute limb ischemia (ALI) in pediatric patients is rare but may lead to limb loss and life-long complications. This study reviewed the experience of a Canadian tertiary pediatric center with the medical and operative management of ALI.
The medical records of inpatients diagnosed with ALI of the upper or lower limb between 1999 and 2012 were reviewed. Patient demographics, arterial clot site and etiology, intervention, anticoagulation type and duration, and short-term and long-term complications were analyzed.
A total of 151 patients (45% female) presented with signs of limb ischemia, of whom 38% were aged <30 days, 46% were between 1 and 12 months, and 16% were between 1 and 18 years. Ninety-four percent of those injuries involved the lower limbs. Ninety-one percent were due to vessel catheterization, 5% were idiopathic, 1% were congenital, and 4% traumatic. Ninety-four percent were managed nonoperatively. Patients were treated with a combination of thrombolysis, unfractionated or low-molecular-weight heparin, aspirin or warfarin, or both (duration, 1 day-13 years). All patients were monitored after discharge at our institution or at their referring hospital (average, 3.4 ± 2.8 years). Fifteen percent had complications related to ALI or anticoagulation (most commonly limb length or thigh circumference discrepancy, or intracranial hemorrhage). Nineteen percent of patients died of unrelated causes (sepsis, multiorgan dysfunction, or cardiac failure).
In contrast with adults, ALI in children can generally be managed nonoperatively with anticoagulation, likely because of their greater ability to develop arterial collaterals. Long-term follow-up by a multidisciplinary team of pediatric and surgical specialists and allied health professionals is integral to achieving a successful outcome in children with ALI.
小儿急性肢体缺血（ALI）虽罕见，但可能导致肢体丧失及终身并发症。本研究回顾了加拿大一家三级儿科中心在ALI药物及手术治疗方面的经验。
回顾1999年至2012年间诊断为上肢或下肢ALI的住院患者病历。分析患者人口统计学资料、动脉血栓部位及病因、干预措施、抗凝类型及持续时间以及短期和长期并发症。
共有151例患者（45%为女性）出现肢体缺血症状，其中38%年龄小于30天，46%年龄在1至12个月之间，16%年龄在1至18岁之间。94%的损伤累及下肢。91%由血管导管插入术引起，5%为特发性，1%为先天性，4%为创伤性。94%采用非手术治疗。患者接受溶栓、普通肝素或低分子肝素、阿司匹林或华法林联合治疗（持续时间为1天至13年）。所有患者出院后在我院或转诊医院接受监测（平均3.4±2.8年）。15%出现与ALI或抗凝相关的并发症（最常见的是肢体长度或大腿周长差异或颅内出血）。19%的患者死于无关原因（败血症、多器官功能障碍或心力衰竭）。
与成人不同，儿童ALI通常可通过抗凝进行非手术治疗，这可能是因为他们形成动脉侧支的能力更强。由儿科和外科专家及相关健康专业人员组成的多学科团队进行长期随访是ALI患儿取得成功治疗效果的关键。
