Blunt Handlebar Injury of the Common Femoral Artery in a Pediatric Patient: Case Report

Abstract

Introduction - Vascular non-iatrogenic trauma in pediatric population is rare. Generally, they are associated to bone fractures, stab or cut wounds. Less common is the blunt trauma as a cause of a vascular lesion. There are implications in the treatment of this kind of lesion associated to the pediatric anatomy, physiology and the growth potential of the pediatric patient. Mainly by the small size of the vessels, thickness of the veins wall or the vascular spasm of the arteries. It’s still controversial which is the best treatment option in these cases, with a wide range of options from medical treatment, direct repair, autogenous saphenous vein graft, ligation and endovascular stenting. Methods - We describe a case of a 9-year-old boy with a very small groin hematoma and an acute left limb ischemia grade IIa after a handle bike trauma 24 hours ago. Ultrasound and CT scan showed a common femoral artery occlusion as well as an absence of femoral vein thrombosis. Results - A surgical treatment was chosen. A common femoral artery approach showed a focal contained artery transection with thrombosis. An autologous panel saphenous vein graft interposition was performed to avoid graft size mismatch. An uneventful postoperative course was developed, and he was discharged 72 hours later. Conclusion - Blunt vascular trauma is a rare condition in pediatric population and clinical suspicion is necessary to avoid a diagnosis delay. The handlebar pressure on the femoral artery against femur or pubis bone may be a traumatic weapon even in not severe bike trauma. Special considerations and technical difficulties should be considerate in the surgical and medical pediatric treatment. There are different options of treatment that depends on the type of injury and the clinical situation. References1Sarfati MR, Galt SW, Treiman GS, Kraiss LW. Common femoral artery injury secondary to bicycle handlebar trauma. J Vasc Surg. 2002 Mar;35(3):589-91.2Mommsen P, Zeckey C, Hildebrand F, Frink M, Khaladj N, Lange N, Krettek C, Probst C. Traumatic extremity arterial injury in children: epidemiology, diagnostics, treatment and prognostic value of Mangled Extremity Severity Score. J Orthop Surg Res. 2010 Apr 15;5:25. doi: 10.1186/1749-799X-5-25.