Delayed Subclavian Artery Revascularization in a Child with Cold Intolerance

Ischemia requiring revascularization is rare in the pediatric population. It is even less common to encounter children requiring a delayed revascularization of the extremities. Adequate arterial circulation is not only necessary for the treatment of cold intolerance, but also for future limb growth and skeletal development. It is known that abnormal ankle brachial indices correlate well with limb length discrepancies. This was a case report of a 10-year-old girl who sustained a penetrating injury to the shoulder, lacerating and avulsing the subclavian vessels and brachial plexus, initially treated by ligation of the vessels and stabilization for hemorrhagic shock. She presented for the first time 9 months after the injury with almost no motor and sensory function, stiff glenohumeral joint, and cold intolerance in her dominant upper extremity. At the vascular physical exam, there was no palpable radial pulse, but presence of a monophasic Doppler signal. She underwent a simultaneous brachial plexus reconstruction and revascularization. An extra-anatomic bypass from the first portion of the subclavian to the brachial artery was performed with a 20-cm reversed saphenous vein graft. These authors presented their rationale for preoperative, operative, and postoperative decision making for a successful microvascular reconstruction and 8-months follow-up.