The Presentation of Iatrogenic Vascular Lesions in Infants

Pediatric surgeon Brian Gilchrist, MD, is the former chief of pediatric surgery at a reputable hospital in the New York metropolitan area. As such, he oversaw the expansion of pediatric surgery service and performed numerous pediatric operations. Throughout his career, Dr. Brian Gilchrist has written and edited over six dozen publications, including an article about iatrogenic vascular lesions.

In infants and children, iatrogenic vascular lesions may present themselves either immediately or well after the original vascular trauma has occurred. Typically, patients with vascular injury display signs straightaway. These signs include the “five Ps”: paralysis, pallor, pulselessness, pain, and paresthesia (a burning sensation in the extremities).

Some of these signs, such as pulselessness and paresthesia, are difficult to determine in infants, but Doppler technology can assist with monitoring flow and comparing pressures to the uninvolved limb. Further, not every sign results from vascular compromise, or the absence thereof. In children, vascular spasms, for example, can result from sources other than lesions, and the presence of a pulse does not rule out vascular injury since roughly 25 percent of patients with vascular injuries presented with distal pulses.

The presentation of the signs of vascular injury is delayed in patients with certain vascular injuries. Those with mycotic aneurysms, renal vascular occlusion, and arteriovenous fistulas, for instance, all display subtle or delayed signs of iatrogenic vascular lesions.