Pseudoaneurysms of the brachial artery following venipuncture in infants

Pediatric vascular injuries are increasing in frequency and represent a challenging problem in pediatric surgical practice. Increased survival of low birth weight infants and advances in invasive diagnostic procedures have resulted in a dramatic increase in the number of these injuries. Formation of pseudoaneurysm of the brachial artery in infants is a very rare complication of venipuncture, with only two cases reported in the literature. We report three cases of brachial artery pseudoaneurysm in infants following venipuncture who were operated upon in our institution, aged 43-64 days at the time of operation. The period from the injury to the operation ranged from 25 to 42 days. All three infants were referred from different institutions. In two infants, the pseudoaneurysms and the involved part of the artery were resected, and arterial continuity was restored with an end-to-end anastomosis; in the other infant, reconstruction was done using a venous interposition graft. All three infants were diagnosed with duplex ultrasonography, and the child requiring a more complex reconstructive procedure was also evaluated with helical contrast computed tomography. Brachial artery pseudoaneurysms are a rare but possible complication of multiple venipuncture in infants. Early diagnosis and microvascular reconstruction are key points in managing these injuries.