Acute Limb Ischemia in an 8-Year-Old Patient: A Case Report

Ann Vasc Surg. 2018 Aug;51:327.e1-327.e8. doi: 10.1016/j.avsg.2018.02.012. Epub 2018 Apr 13.

Abstract

We report the case of an 8-year-old patient with a history of nephrotic syndrome, who presented to the emergency department with right foot pain. The patient's mother described intermittent pain that woke her son from sleep and was accompanied by the foot turning purple and becoming cold to touch. Physical examination revealed capillary refill of over 10 seconds in the right and less than 2 seconds in the left foot. Ankle-brachial indices (ABIs) were 0.0 on the right and 0.96 on the left. The patient was admitted and started on therapeutic intravenous heparin. After consultation with his parents, right lower extremity angiography and thrombolysis was performed over 2 days. He subsequently underwent fasciotomy and amputation of the tip of all 5 toes. Eighteen months later, there is no leg length discrepancy, he is walking with foot inserts and has normal ABIs bilaterally.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Administration, Intravenous
  • Amputation
  • Ankle Brachial Index
  • Anticoagulants / administration & dosage
  • Child
  • Fasciotomy
  • Glucocorticoids / administration & dosage
  • Heparin
  • Humans
  • Ischemia / diagnosis
  • Ischemia / etiology*
  • Ischemia / physiopathology
  • Ischemia / therapy
  • Lower Extremity / blood supply*
  • Male
  • Nephrotic Syndrome / complications*
  • Nephrotic Syndrome / diagnosis
  • Nephrotic Syndrome / drug therapy
  • Peripheral Arterial Disease / diagnosis
  • Peripheral Arterial Disease / etiology*
  • Peripheral Arterial Disease / physiopathology
  • Peripheral Arterial Disease / therapy
  • Thrombolytic Therapy
  • Treatment Outcome
  • Ultrasonography, Doppler, Duplex

Substances

  • Anticoagulants
  • Glucocorticoids
  • Heparin