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      Trombosis de la arteria femoral en un neonato pretérmino extremo Translated title: Femoral artery thrombosis in an extremely preterm newborn

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          Abstract

          Resumen Introducción: la trombosis arterial en neonatos es mayoritariamente secundaria a complicaciones en la cateterización. La anticoagulación es la piedra angular del tratamiento en la isquemia aguda. La trombosis persistente se manifiesta con asimetrías en el volumen del miembro y claudicación. La revascularización electiva tiene su lugar en la isquemia crónica. Caso clínico: presentamos el caso de una recién nacida prematura extrema con trombosis de arteria femoral como complicación de una descubierta para una cateterización venosa central. Se inició anticoagulación precozmente y logró la preservación del miembro con secuelas. Discusión: el trauma iatrogénico de la arteria femoral complica el curso de neonatos y niños en estado crítico y tiene una mortalidad del 12-20 %. La rápida regeneración tisular en la edad pediátrica son factores protectores. La trombosis femoral en niños se manifiesta generalmente como isquemia aguda y su buen pronóstico funcional está en relación con la plasticidad en la edad pediátrica.

          Translated abstract

          Abstract Introduction: most arterial thrombosis in a newborn is catheter-related. Anticoagulant therapy is the cornerstone of treatment of acute ischemia. Persistent thrombosis causes limb-length discrepancy and intermittent claudication. Elective arterial revascularization plays a role in the management of chronic limb ischaemia. Case report: we present the case of an extremely preterm newborn with femoral artery thrombosis caused in an attempt of vein catheterization. Early anticoagulation therapy was initiated and the limb was preserved with sequelae. Discussion: iatrogenic trauma in the femoral artery complicates the course of neonate and children and has a 12-20 % mortality rate. The quick regeneration of the tissue in pediatric age is a protecting factor. Femoral thrombosis in children manifests generally as acute isquemia and its good prognostic is correlated with the plasticity of the pediatric age.

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          Most cited references6

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          Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.

          Neonates and children differ from adults in physiology, pharmacologic responses to drugs, epidemiology, and long-term consequences of thrombosis. This guideline addresses optimal strategies for the management of thrombosis in neonates and children. The methods of this guideline follow those described in the Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. We suggest that where possible, pediatric hematologists with experience in thromboembolism manage pediatric patients with thromboembolism (Grade 2C). When this is not possible, we suggest a combination of a neonatologist/pediatrician and adult hematologist supported by consultation with an experienced pediatric hematologist (Grade 2C). We suggest that therapeutic unfractionated heparin in children is titrated to achieve a target anti-Xa range of 0.35 to 0.7 units/mL or an activated partial thromboplastin time range that correlates to this anti-Xa range or to a protamine titration range of 0.2 to 0.4 units/mL (Grade 2C). For neonates and children receiving either daily or bid therapeutic low-molecular-weight heparin, we suggest that the drug be monitored to a target range of 0.5 to 1.0 units/mL in a sample taken 4 to 6 h after subcutaneous injection or, alternatively, 0.5 to 0.8 units/mL in a sample taken 2 to 6 h after subcutaneous injection (Grade 2C). The evidence supporting most recommendations for antithrombotic therapy in neonates and children remains weak. Studies addressing appropriate drug target ranges and monitoring requirements are urgently required in addition to site- and clinical situation-specific thrombosis management strategies.
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            Surgical intervention for complications caused by femoral artery catheterization in pediatric patients.

            This study evaluated the risk factors and surgical management of complications caused by femoral artery catheterization in pediatric patients. From January 1986 to March 2001, the hospital records of all children who underwent operative repairs for complications caused by femoral artery catheterization were reviewed. A prospective cardiac data bank containing 1674 catheterization procedures during the study period was used as a means of determining risk factors associated with iatrogenic femoral artery injury. Thirty-six operations were performed in 34 patients (age range, 1 week-17.4 years) in whom iatrogenic complications developed after either diagnostic or therapeutic femoral artery catheterizations during the study period. Non-ischemic complications included femoral artery pseudoaneurysms (n = 4), arteriovenous fistulae (n = 5), uncontrollable bleeding, and expanding hematoma (n = 4). Operative repairs were performed successfully in all patients with non-ischemic iatrogenic femoral artery injuries. In contrast, ischemic complications occurred in 21 patients. Among them, 14 patients had acute femoral ischemia and underwent surgical interventions including femoral artery thrombectomy with primary closure (n = 6), saphenous vein patch angioplasty (n = 6), and resection with primary anastomosis (n = 2). Chronic femoral artery occlusion (> 30 days) occurred in seven patients, with symptoms including either severe claudication (n = 4) or gait disturbance or limb growth impairment (n = 3). Operative treatments in these patients included ileofemoral bypass grafting (n = 5), femorofemoral bypass grafting (n = 1), and femoral artery patch angioplasty (n = 1). During a mean follow-up period of 38 months, no instances of limb loss occurred, and 84% of children with ischemic complications eventually gained normal circulation. Factors that correlated with an increased risk of iatrogenic groin complications that necessitated surgical intervention included age younger than 3 years, therapeutic intervention, number of catheterizations (>or= 3), and use of 6F or larger guiding catheter. Although excellent operative results can be achieved in cases of non-ischemic complications, acute femoral occlusion in children younger than 2 years often leads to less satisfactory outcomes. Operative intervention can provide successful outcome in children with claudication caused by chronic limb ischemia. Variables that correlated with significant iatrogenic groin complications included a young age, therapeutic intervention, earlier catheterization, and the use of a large guiding catheter.
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              Management of acute limb ischemia in the pediatric population.

              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.
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                Author and article information

                Journal
                angiologia
                Angiología
                Angiología
                Arán Ediciones S.L. (Madrid, Madrid, Spain )
                0003-3170
                1695-2987
                October 2021
                : 73
                : 5
                : 239-242
                Affiliations
                [3] Montevideo orgnameUniversidad de la República orgdiv1Facultad de Medicina Uruguay
                [1] Montevideo orgnameHospital de Clínicas Dr. Manuel Quintela orgdiv1Servicio de Cirugía Vascular Periférica Uruguay
                [2] Montevideo orgnameHospital Pasteur orgdiv1Servicio de Cirugía Vascular Uruguay
                Article
                S0003-31702021000500004 S0003-3170(21)07300500004
                10.20960/angiologia.00291
                33fad0ee-6d23-4a95-bafe-3a77c7234cfe

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 27 March 2021
                : 27 February 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 6, Pages: 4
                Product

                SciELO Spain

                Categories
                Casos Clínicos

                Ischemia neonate,Trombosis arterial neonato,Isquemia neonato,Recién nacido prematuro,Extremidad inferior,Isquemia,Arteria femoral,Dispositivos de acceso vascular,Arterial thrombosis neonate,Premature infant,Lower extremity,Ischemia,Femoral artery,Vascular access devices

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