A systematic review of the management of acute limb ischemia in children

OBJECTIVE: Literature on paediatric acute limb ischemia is scarce with controversial management regarding diagnostics and treatment. The aim of this review was to evaluate the management of paediatric acute limb ischemia (PALI).

METHODS: A systematic literature search (PubMed, Embase, Cochrane Library) following PRISMA guidelines was performed (Prospero registration number CRD420251035570). All English full text studies published in the last 30 years reporting on acute limb ischemia in children were included. Cases series and cohorts with fewer than 10 patients were excluded from the pooled analysis. Primary outcome were treatment modalities and used diagnostics. Secondary outcomes were: recorded mortality directly linked to PALI, etiology of PALI as well as long-term morbidity and amputation rates.

RESULTS: In all, 17 studies (2484 children, 66.3% male, mean age 2.14 years) were included in the quantitative synthesis. In 89.9% PALI was caused by arterial cannulation. Most commonly affected location was the common femoral artery (49.8%). Ultrasound was the most commonly used diagnostic means. Conservative treatment of PALI was first-line treatment in 87% and was considered successful without the need for surgical intervention (65% of reports, 11/17). Surgery was reserved for failed conservative treatment with an amputation rate of 2.4%. Mortality directly related to PALI was low (0.01%).

CONCLUSION: Acute ischemia in paediatric patients most often occurred iatrogenic. Conservative treatment proved to be successful and should be considered as treatment of choice.