Salimi Javad, Ahrabi Amirali
Vascular Surgery Department of Sina Hospital, Tehran, Iran.
Sina Trauma and Surgery Research Center, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
SAGE Open Med Case Rep. 2025 Jun 13;13:2050313X251347827. doi: 10.1177/2050313X251347827. eCollection 2025.
Available data regarding iatrogenic vascular trauma in the pediatric population mainly comprise case reports and series, with management protocols not firmly established. This study aims to report seven pediatric cases of iatrogenic vascular trauma in the extremities, presenting as arteriovenous fistula and pseudoaneurysm, along with their surgical management. We further reviewed the literature and discussed other possible management approaches for arteriovenous fistula and pseudoaneurysm in this specific population. We reviewed the cases of seven pediatric patients (six male and one female) with iatrogenic vascular trauma presenting as arteriovenous fistula and pseudoaneurysm in their extremities. Four patients (57%) were admitted to the intensive care unit due to their severe medical condition before developing these complications. Arterial injury during venous access accounted for five cases (71%). Two patients developed arteriovenous fistula after cardiac catheterization through the common femoral artery for their underlying tetralogy of Fallot. All patients underwent surgical repair. While arteriovenous fistula and pseudoaneurysm are infrequent, their occurrence is on the rise, primarily due to the more frequent use of venous access and catheterization procedures. Surgical approaches include ligation and lateral arteriorrhaphy/venorrhaphy, or resection with arterial end-to-end anastomosis. Despite the growing preference for endovascular treatment in the adult population, such as stent placement or coil embolization, pediatric patients require meticulous attention to the possible risk of stent migration, chronic ischemia, and radiation exposure. Based on our experience, surgical management has generally provided a satisfactory treatment response and recovery. However, this needs to be further evaluated in larger, prospective studies.
关于儿科人群医源性血管创伤的现有数据主要包括病例报告和系列研究，管理方案尚未牢固确立。本研究旨在报告7例儿科四肢医源性血管创伤病例，表现为动静脉瘘和假性动脉瘤，以及它们的手术治疗。我们进一步回顾了文献，并讨论了针对这一特定人群动静脉瘘和假性动脉瘤的其他可能管理方法。我们回顾了7例儿科患者（6例男性和1例女性）的病例，这些患者在四肢出现医源性血管创伤，表现为动静脉瘘和假性动脉瘤。4例患者（57%）在出现这些并发症之前因病情严重被收入重症监护病房。静脉穿刺过程中的动脉损伤占5例（71%）。2例患者因潜在的法洛四联症通过股总动脉进行心导管检查后发生动静脉瘘。所有患者均接受了手术修复。虽然动静脉瘘和假性动脉瘤并不常见，但它们的发生率正在上升，主要是由于静脉穿刺和导管插入术的使用更加频繁。手术方法包括结扎和动脉/静脉侧壁修补术，或切除并进行动脉端端吻合术。尽管在成人人群中越来越倾向于血管内治疗，如支架置入或弹簧圈栓塞，但儿科患者需要特别关注支架移位、慢性缺血和辐射暴露的可能风险。根据我们的经验，手术治疗总体上提供了令人满意的治疗反应和恢复情况。然而，这需要在更大规模的前瞻性研究中进一步评估。
