Adamson Karri A, Braza Matthew E, LoGiudice John A, Dzwierzynski William W
Department of Plastic Surgery, The Medical College of Wisconsin, WI, USA.
J Neonatal Perinatal Med. 2018;11(1):105-108. doi: 10.3233/NPM-181724.
Two neonates with congenital heart disease, one and thirty-one days old respectively, suffered inadvertent arterial injury from cardiac catheterization. Both insults resulted in unrecognized avulsion of the external iliac artery from its origin. The patients quickly decompensated, with their right lower extremities becoming critically ischemic. In both cases, segments of reversed greater saphenous vein were used as interposition grafts from the common iliac artery to the common femoral artery. Reperfusion of the right foot was immediate for the one-day-old. She is now three years old and able to run, but is followed for a mild limb length discrepancy. The 31-day-old had restoration of flow to the right limb; however, the foot remained ischemic and eventually required transmetatarsal amputation. She is now 16 months old and able to crawl; she also is followed for limb length discrepancy. Without vein grafting, both infants would likely have lost their affected limbs, and possibly lost their lives. These cases advocate for microsurgical repair of arterial injuries in even the youngest patients, and promote the use of vein grafts when direct anastomosis is not feasible.
两名分别为1天和31天大的先天性心脏病新生儿在心脏导管插入术中意外发生动脉损伤。两次损伤均导致髂外动脉从其起始处发生未被识别的撕脱。患者迅速出现失代偿，右下肢严重缺血。在这两例病例中，均使用了大隐静脉倒置段作为从髂总动脉到股总动脉的搭桥移植物。1天大的患儿右脚立即恢复灌注。她现在3岁，能够跑步，但因轻度肢体长度差异而接受随访。31天大的患儿右下肢血流恢复；然而，足部仍缺血，最终需要进行经跖骨截肢。她现在16个月大，能够爬行；她也因肢体长度差异而接受随访。如果不进行静脉移植，两名婴儿很可能会失去受影响的肢体，甚至可能失去生命。这些病例提倡即使是最年幼的患者也应进行动脉损伤的显微外科修复，并在直接吻合不可行时推广使用静脉移植物。
