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• Author's reply:" Brachial atery pseudoaneurysm in a premature infant"
  Landau Daniella
  Published on: 9 January 2022
• Re: Brachial artery pseudoaneurysm in a premature infant
  Denis A Cozzi
  Published on: 9 January 2022

• Published on: 9 January 2022

  Author's reply:" Brachial atery pseudoaneurysm in a premature infant"

  • Landau Daniella, Neonatologist
  • Other Contributors:
    • Szendro G, Head of Vascular Surgery Dept, Soroka Medical Center and the Faculty of Health Sciences,Beer-Sheva, Israel,szendrog@hotmail.com

  Dear Editor

  We thank Cozzi et al.for their communication regarding our report "Brachial artery pseudoaneurysm in a premature infant".[1] Follow-up period is now 18 months long and the vascular repair is patent. Indeed, resection without reconstruction is also an option in infancy and childhood, and is usually harmless. The size of the lesion before surgery was 2x3 cm. Our own success rate with ultrasound guided...

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  Dear Editor

  We thank Cozzi et al.for their communication regarding our report "Brachial artery pseudoaneurysm in a premature infant".[1] Follow-up period is now 18 months long and the vascular repair is patent. Indeed, resection without reconstruction is also an option in infancy and childhood, and is usually harmless. The size of the lesion before surgery was 2x3 cm. Our own success rate with ultrasound guided compression repair (UGCR) is also very high even in much larger lesions but only when appropriate neck exists. In this case, the size of the arterial defect relative to the diameter of the artery made UGCR impossible. Complete spontaneous obliteration may occur but the risk of bleeding in an infant is much more dangerous than in adults. We did not try occlusive bandaging of the lesion. It may be suitable in radial or ulnar lesions with good enough collateral circulation, however this may not apply to the brachial artery.

  Reference

  (1) Cozzi DA, Morini F, Pacilli M. Re: Brachial artery pseudoaneurysm in a premature infant [electronic response to Landau D et al. Brachial artery pseudoaneurysm in a premature infant] archdischild.com 2003 http://adc.bmjjournals.com/cgi/eletters/fetalneonatal;88/2/F152#192

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  Conflict of Interest:
  None declared.

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• Published on: 9 January 2022

  Re: Brachial artery pseudoaneurysm in a premature infant

  • Denis A Cozzi, <i>et al</i>.
  • Other Contributors:
    • Francesco Morini, and Maurizio Pacilli.

  Dear Editor

  We read with interest the article by Landau and colleagues who reported on an uncomplicated iatrogenic pseudoaneurysm of the brachial artery treated by excision and primary reconstruction of the injured vessel.[1] Although there remains a reluctance to repair arterial lesions in small babies, microvascular interventions may restore adequate perfusion and limb recovery without tissue loss.[2] However...

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  Dear Editor

  We read with interest the article by Landau and colleagues who reported on an uncomplicated iatrogenic pseudoaneurysm of the brachial artery treated by excision and primary reconstruction of the injured vessel.[1] Although there remains a reluctance to repair arterial lesions in small babies, microvascular interventions may restore adequate perfusion and limb recovery without tissue loss.[2] However, the authors did not mention the precise duration of follow-up after surgery. In fact, in patients undergoing vascular procedures in infancy, spasm or stenosis of the repaired artery may lead to subsequent disturbance of the limb growth at long-term follow-up, despite initial, successful revascularization.[2] By contrast, the reported experience with conservative management of these vascular lesions in infancy and childhood is very limited. The authors initially opted for ultrasound-guided compression repair (UGCR), but after two unfruitful attempts considered the infant a candidate for surgery owing to the progressive enlargement of the lesion. However, no details were given regarding the tumour size at UGCR abandonment or at surgery. In fact, the success rate of UGCR is not dependent on the size of the lesion, and in adults pseudoaneurysms as large as 5.2 cm diameter have been cured by this technique.[3] Since the lesion was partially thrombosed, it is possible that spontaneous healing would have occurred. Perhaps, while awaiting appropriate surgical timing, the infant could have still benefited from some non-invasive therapeutic procedures. We recently described a child with post-traumatic uncomplicated pseudoaneurysm of the radial artery successfully cured by simple compression bandage.[4] In infants and children with uncomplicated arterial pseudoaneurysms of the upper extremities, the application of an occlusive bandage is a safe, non-invasive and effective treatment. Caregivers should be aware of this therapeutic tool, which may be considered the first line treatment for these vascular lesions.

  References

  (1) Landau D, Schreiber R, Szendro G, et al. Brachial artery pseudoaneurysm in a premature infant. Arch Dis Child Fetal Neonatal Ed 2003;88:F152-9.

  (2) La Quaglia MP, Upton J, May JW Jr. Microvascular reconstruction of major arteries in neonates and small children. J Pediatr Surg 1991;26:1136-40.

  (3) Cox GS, Young JR, Gray BR, et al. Ultrasound-guided compression repair of postcatheterization pseudoaneurysms: results of treatment in one hundred cases. J Vasc Surg 1994;19:683-6.

  (4) Cozzi DA, Morini F, Casati A, et al. Radial artery pseudoaneurysm successfully treated by compression bandage. Arch Dis Child 2003;88:165-6.

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  Conflict of Interest:
  None declared.

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