Brachial artery injury in pediatric patients: review of management and outcome in 29 patients

Background: The brachial artery is the most frequently injured artery in the upper extremity due to its vulnerability and commonly it is associated with road traffic accidents and occupational injuries. But brachial artery injury in pediatric age group is not very frequent as in adults and commonly associated with supracondylar fracture of humerus. They may present with or without features of ischemia. Prompt diagnosis and treatment is essential for salvage of limb in established ischemia. Obscure presentation of arterial injury poses challenge in early diagnosis and treatment. Repair of the injured artery in these cases is not clearly recommended. We are presenting a series of 29 pediatric brachial artery injuries and their outcome in our institute over the last 5 years.Methods: Twenty nine pediatric patients with brachial artery injury managed in our institute between 2014 to 2018 are assessed retrospectively for operative procedure and outcome.Results: Supracondylar fracture was the most common cause (55.17%). Ischemic and non-ischemic presentation was noted in 41.37% and 69.63% cases respectively. Artery repair was done in 17 (58.62%) cases. Primary repair and interposition vein graft repair was done 8 and 9 cases respectively. Among the 17 repaired artery good functional outcome with Grade 5/5 muscle power noted in 14cases. Amputation was done in two cases.Conclusions: Good functional recovery may be achieved in segmental injury repair with a vein graft. Though in closed injury without ischemic features artery may not be repaired, full functional recovery is possible due to collateral circulations. Obscure presentation detected and repaired early also has a satisfactory result.