Acute Limb Ischaemia in Infants and Children Under 2 — When Initial Heparin Management Has Not Worked

This protocol addresses aortoiliac embolism presenting as acute limb ischaemia in infants and children younger than 2 years of age, specifically in the situation where initial conservative management has not achieved the required therapeutic response and a next step is needed.

Clinical Scenario

Acute limb ischaemia in infants and young children — with emphasis on those under 2 years of age. In this age group, conservative management with systemic heparinisation is the recommended first-line approach.

Previous Treatment — Target Not Achieved

When conservative management with systemic heparinisation fails to achieve an activated partial thromboplastin time (APTT) in the range of 55–85 seconds, further escalation becomes necessary. This protocol is indicated following that failure condition.

Next-Line Treatment Approach

After conservative heparin therapy has not produced the required response, the approach may involve thrombolysis or a surgical revascularisation strategy. The full decision pathway, including criteria and sequencing, is set out in the complete protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.ejvs.2019.09.006

For infants and children younger than 2 years of age with acute limb ischaemia, initial conservative management with heparin is recommended.

For infants and children with acute limb ischaemia without improvement after conservative therapy with heparin, thrombolysis, or open surgical revascularisation may be considered.

View source ↗