Challenges in Treating Neonatal Acute Limb Ischemia: Conservative Management With Successful Limb Salvage.

Case Reports in Vascular Medicine Pub Date : 2025-03-24 eCollection Date: 2025-01-01 DOI:10.1155/crvm/2424543
Ayman Bsat, Leonard Lawandos, Sami Nabhani, Bassel Hafez, Fady Haddad
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Abstract

Acute limb ischemia (ALI) in neonates is a rare but critical condition often resulting from iatrogenic causes, such as arterial catheterization. This case highlights the unique challenges in diagnosing and managing ALI in this population, where evidence-based guidelines are scarce and treatment decisions rely heavily on expert consensus and extrapolation from adult data. We report the case of a premature neonate, born at 30 weeks' gestation, who developed ALI secondary to femoral artery thrombosis following arterial line insertion. The patient presented with bluish discoloration, diminished capillary refill, and absent distal pulses in the affected limb. Duplex ultrasonography confirmed occlusion of the right common femoral artery. Conservative management with anticoagulation and close observation was adopted by multidisciplinary consensus involving neonatology and vascular surgery. Despite signs of worsening ischemia and skin necrosis during therapeutic anticoagulation, the team opted to continue conservative management due to the high surgical risk posed by the patient's prematurity and multiple comorbidities. Over the next week, gradual clinical and imaging improvements were noted, including recanalization of the occluded artery and restoration of arterial flow, ultimately leading to successful limb salvage. This case underscores the importance of individualized, multidisciplinary decision-making in managing neonatal ALI. Conservative management with therapeutic anticoagulation can achieve favorable outcomes, even in cases with worsening ischemia, provided that close monitoring and optimal supportive care are ensured. It also highlights the need for further research to develop standardized pediatric guidelines for this rare but potentially devastating condition.

治疗新生儿急性肢体缺血的挑战:保守管理和成功的肢体保留。
新生儿急性肢体缺血(ALI)是一种罕见但危险的疾病,通常由医源性原因引起,如动脉导管插入术。这一病例凸显了这一人群在诊断和管理ALI方面面临的独特挑战,在这一人群中,循证指南很少,治疗决策严重依赖专家共识和成人数据的推断。我们报告的情况下,早产新生儿,出生在妊娠30周,谁发展继发股动脉血栓栓塞动脉线插入后ALI。患者表现为浅蓝色,毛细血管充盈减少,患肢远端脉搏消失。超声检查证实右侧股总动脉闭塞。经涉及新生儿和血管外科的多学科共识,采用抗凝和密切观察的保守治疗。尽管在抗凝治疗期间有缺血和皮肤坏死恶化的迹象,但由于患者早产和多种合并症带来的手术风险很高,研究小组选择继续保守治疗。在接下来的一周,临床和影像学逐渐改善,包括闭塞动脉的再通和动脉血流的恢复,最终导致成功的肢体保留。本病例强调了个性化、多学科决策在处理新生儿ALI中的重要性。即使在缺血恶化的情况下,只要确保密切监测和最佳支持护理,保守治疗抗凝也能取得良好的结果。它还强调需要进一步研究,为这种罕见但具有潜在破坏性的疾病制定标准化的儿科指南。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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