Treatment and 5-Year Follow-Up of a 3-Year-Old Boy With Transection of Femoral Artery and Vein

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The purpose of this study was to present the treatment of a 3-year-old boy with transection of his right femoral artery and vein due to dog bite. This case report discusses the operative treatment of a 3-year-old boy with traumatic transection of the femoral artery and vein (Fig 1). A 5-year follow-up period is provided with review of his vascular laboratory studies. A reversed cryopreserved great saphenous vein graft was used to reconstruct the right femoral artery. The patient recovered after 13 separate operations requiring skin graft, irrigation, and débridement. He was discharged after 8 weeks of hospitalization with palpable pedal pulses. He was also prescribed warfarin for 6 months and closely observed every month for the first 6 months with physical examination. His groin wound was noted to be completely healed at 5 months. Arterial duplex scanning of the right femoral arterial allograft was performed at 3 months, 6 months, and then yearly intervals. Five years after injury, arterial duplex ultrasound showed patency of the vascular reconstruction without aneurysmal dilation of the graft (Fig 2). There is also no significant right leg swelling. The triad for successful management of vascular trauma in pediatric patients is a high index of suspicion, performance of aggressive studies when indicated, and prompt surgical intervention with exploration and reconstruction if possible. That our patient continues to do well 5 years out from allograft vascular reconstruction in spite of the dismal patency reported with the use of cryopreserved grafts in adult patients may suggest a greater role for its application in the treatment of complex pediatric vascular injury when autologous conduit is not available.Fig 2Arterial duplex showed patency of the vascular reconstruction without aneurysmal graft dilatation.View Large Image Figure ViewerDownload Hi-res image Download (PPT)