Brachial artery repair using the basilic vein as a reliable conduit in a 3-year-old child

Hyunyoung G. Kim, Manisha B. Bhatia, Samantha A. Moore, John W. Fitzwater, Dixon Santana

Research output: Contribution to journalArticle

Abstract

A supracondylar fracture of the humerus is the most common upper extremity fracture in children with concurrent neurovascular complications. However, bypass grafting in the management of a pediatric open elbow dislocation with an arterial injury has rarely been reported in the literature. Hence, an adequate conduit for a vessel graft interposition remains questionable when a primary anastomosis is limited in an arterial reconstruction. The purpose of this study is to present a brachial artery reconstruction in a 3-year-old patient with an open supracondylar fracture of the humerus. In the clinical and surgical examination of the patient, an open wound in the left antecubital fossa presented with accompanying brachial artery injury. To repair the artery, a reverse end-to-end anastomosis was conducted using basilic vein graft from the ipsilateral arm under general anesthesia. The patient had palpable radial pulses in the postoperative clinical examination and was discharged without complications. The great saphenous vein (GSV) has proven to be the most common and the best conduit for arterial reconstruction of the upper extremity in the adult patients. However, the GSV graft is known to have the propensity for becoming aneurysmal in pediatric patients. Some studies have demonstrated the basilic vein as a suitable conduit in pediatric patients, in that it has durable patency, fewer branches, size compatibility for anastomosis, and proximity to the brachial artery. Our case confirms the safety of using this autogenous vein from within the zone of injury for arterial reconstruction, after a supracondylar humeral fracture. The management of pediatric elbow fractures accompanying vascular injuries can be technically demanding due to relatively small, delicate structures and concurrent neurovascular network. Nonetheless, a vascular injury should be treated with high level of suspicion and immediate intervention to avoid any limb ischemia or loss. In situations where the brachial artery is compromised and needs repair with a bypass, the basilic vein should be considered as a conduit for its greater accessibility and long-term patency.

Original languageEnglish (US)
Pages (from-to)16-18
Number of pages3
JournalJournal of Pediatric Surgery Case Reports
Volume19
DOIs
StatePublished - Apr 1 2017
Externally publishedYes

Fingerprint

Brachial Artery
Veins
Pediatrics
Vascular System Injuries
Humerus
Saphenous Vein
Elbow
Transplants
Upper Extremity
Arm Injuries
Wounds and Injuries
Humeral Fractures
Open Fractures
General Anesthesia
Arm
Ischemia
Extremities
Arteries
Safety

Keywords

  • Artery repair
  • Basilic vein graft
  • Brachial artery
  • Pediatric vascular injury

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

Cite this

Brachial artery repair using the basilic vein as a reliable conduit in a 3-year-old child. / Kim, Hyunyoung G.; Bhatia, Manisha B.; Moore, Samantha A.; Fitzwater, John W.; Santana, Dixon.

In: Journal of Pediatric Surgery Case Reports, Vol. 19, 01.04.2017, p. 16-18.

Research output: Contribution to journalArticle

Kim, Hyunyoung G. ; Bhatia, Manisha B. ; Moore, Samantha A. ; Fitzwater, John W. ; Santana, Dixon. / Brachial artery repair using the basilic vein as a reliable conduit in a 3-year-old child. In: Journal of Pediatric Surgery Case Reports. 2017 ; Vol. 19. pp. 16-18.
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