Iatrogenic vascular trauma of the extremities in pediatric patients: A case series report and review of literature

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.