Vascular Trauma in Children-Review from a Major Paediatric Center (original) (raw)
Related papers
Journal of Vascular Surgery, 1994
Purpose: The purpose of this study was to determine the contribution of blunt vascular trauma to death and disability in children. Methods: We reviewed the medical records of 41 patients aged 17 years and younger requiring operative intervention for 48 blunt vascular injuries during the past 18 years. Results: Eight patients had arterial injuries (seven brachial, one superficial femoral) associated with orthopedic trauma resulting from falls. All eight were associated with a pulse deficit and were easily recognized. None of the eight had late sequelae after vascular repair. Thirty-three patients had vascular trauma as a result of motor vehicle crashes (n = 17), motor vehicle/pedestrian accidents (n = 12), or severe crush injuries (n = 4). Twenty-one (64%) were admitted in shock. Twenty-one major abdominal venous injuries were present in 17 patients and were lethal in 11 (65%). Abdominal venous injuries were not recognized before laparotomy. Nine of the 33 (27%) patients had extremity vascular injuries associated with orthopedic trauma, and three (9%) had major injuries of thoracic vessels. Only three patients had major abdominal arterial injuries in this series. Conclusions: Vascular injuries resulting from blunt trauma are rare in the pediatric age group. Whereas blunt arterial injuries associated with long bone fractures are readily recognized, easily treated, and result in minimal late morbidity, blunt abdominal venous injuries are rarely recognized before exploration and are lethal in more than half. Devastating venous injuries are more common than arterial injuries after blunt abdominal trauma in children. (
Noniatrogenic pediatric vascular trauma
Journal of Vascular Surgery, 1989
Twenty-four noniatrogenic pediatric vascular injuries in 20 patients (75% male; mean age, 14 years) were treated during a 3-year period. Of 18 arterial and six venous injuries, 65% were penetrating and 35% were blunt injuries. Eighty percent of all patients had significant associated injuries that required repair. Angiography was performed in 13 of 20 patients, with four performed during surgery. Repair methods were ligation in two of six venous injuries and three of 18 arterial injuries, primary repair in three of six venous injuries and six of 18 arterial injuries, and autogenous saphenous vein graft in seven of 18 arterial injuries. Exploration and debridement, thrombectomy, and nonoperative management were used in one arterial injury each. Fasciotomy was employed in six of 13 arterial injuries in the extremities. There was one operative death, no reoperations, and no early or late amputations. Mean follow-up of 27 months demonstrated normal palpable and Doppler pulses (by noninvasive testing) distal to all arterial repairs. This study supports an aggressive approach to the diagnosis and treatment ofnoniatrogenic pediatric vascular trauma, emphasizing the liberal use of fasciotomy and meticulous vasctflar repair for the successfitl management of these challenging injuries.
Outcomes of truncal vascular injuries in children
Journal of Pediatric Surgery, 2009
Background-Pediatric truncal vascular injuries occur infrequently and have a reported mortality rate of 30% to 50%. This report examines the demographics, mechanisms of injury, associated trauma, and outcome of patients presenting for the past 10 years at a single institution with truncal vascular injuries. (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006) of a pediatric trauma registry at a single institution was undertaken.
Treatment of pediatric vascular injuries: the experience of a single non-pediatric referral center
International Angiology, 2019
Background: Pediatric peripheral vascular trauma carries significant risk of complications including limb loss and long-term invalidity. Mechanisms and types of morphological lesions are very diverse. The objectives of this study are to present the experience of a single vascular center in the surgical approach to pediatric vascular injuries, and to analyze the main challenges related to this clinical entity. Methods: Over a period of 25 years, 17 pediatric peripheral vascular injuries were treated in our institution. Patient's age ranged between one day (newborn) and 15 years (mean: 10.7 years). There were five injuries of upper and 12 injuries of the lower extremity. Preoperative diagnosis was established by clinical examination (N.=4), ultrasonography (N.=1) and angiography (N.=12). Blunt trauma mainly caused arterial thrombosis while penetrating trauma caused arterial laceration or complete transection. Five patients had associated orthopedic injuries (29,4%). There were two posttraumatic pseudoaneurysms and two arterio-venous fistulas. Results: There was no perioperative mortality. Vascular reconstructions included arterial suture (N.=4), thrombectomy + patch angioplasty (N.=1), termino-terminal anastomosis (N.=3), venous anatomic bypass (N.=6), PTFE graft reconstruction (N.=2), and venous extra-anatomic reconstruction (N.=1). Two patients had associated venous injury demanding both arterial and venous reconstruction. In the only case of war trauma treatment ended with limb loss. Other reconstructions presented good early and long-term patency. Conclusions: Pediatric vascular injuries are extremely challenging issues. Treatment includes broad spectrum of different types of vascular reconstructions. It should be performed by vascular surgeon trained in open vascular treatment or pediatric surgeon with significant experience in vascular surgery.
Non iatrogenic paediatric vascular trauma of the extremities and neck
African Journal of Paediatric Surgery, 2009
Aim: Vascular trauma in children is uncommon. Considering the complexity of these injuries, we have tried to determine their demographic data, the different factors changing their outcome, the different modalities of management, and their outcomes. Patients and Methods: We reviewed the medical records of 52 pediatric patients of less than 15 years f age for about ten years (1996 to 2006) .The review was followed by physical examination done by two surgeons. Vascular injuries included blunt and penetrating injuries to the neck and extremities. Their management included conservative management, primary closure, end-to-end anastomosis, graft interpositioning, and fasciotomy. Results: The patients included 41 males and 11 females and their mean age was 9.7 years (ranging from 3 to 14 years). Males were signifi cantly more (78%) involved. Penetrating upper extremity injuries were the most common cause of vascular injury in the paediatric population (65% on the right side). The most common mechanism was cutting the hand by glass (most of them on the ulnar side). These vascular injuries per se did not cause any disability in the upper extremities. The outcome of these injuries depended more on simultaneous nervous injury and to a lesser extent, on tendon injury. There was no signifi cant long-term difference between ligation and anastomosis of the radial and ulnar arteries. Lower extremity vascular injuries had signifi cantly higher mortality and morbidity. Conclusion: As the reconstructive procedures to manage vascular injuries are technically diffi cult, we suggest conservative managements to be applied fi rst. Prompt surgical intervention is necessary if there are any critical signs of ischaemia or unsuccessful conservative management,
Current Opinions in Open and Endovascular Treatment of Major Arterial Injuries in Pediatric Patient
Journal of Clinical Medicine
Pediatric major arterial vascular injuries may belong to the same principal categories as adults, but have been poorly documented, with an estimated overall incidence of <2% of all vascular traumas. Open surgery has been the mainstay of treatment, but no clear guidelines have been developed to recommend the best practice patterns in terms of strategy or repair as well as postoperative pharmacological regimen. Herein, we report three cases and a narrative review of the available literature regarding the main aspects when dealing with pediatric arterial injuries based on the predominant series available from the most recent published literature.
Journal of the American College of Surgeons, 2018
To evaluates the management and outcome of non-iatrogenic pediatric and adolescence extremity arterial injuries in a resource-challenged setting. Methods: A retrospective study of the surgical management for non-iatrogenic extremity arterial trauma in pediatric and adolescence during the period from January 2008 to December 2015. This study was performed in two different countries at tertiary referral university and teaching hospitals having a specialized emergency and trauma centers. A thorough study of each patient record was collected from these centers including, the original demographic data and their clinical presentations. Operative data of each patient was also reported. Results: During the 8-year period of the study, 149 pediatric and adolescent extremity arterial trauma patients were treated. They were 93.3% male, and 6.7% female, respectively. The age ranged from 2 to 18 years with a mean of 10.25 AE 4.05 years. Lower extremity arterial trauma was recorded in 51%, while 49% were having upper extremity injuries. Primary repair with endto-end vascular anastomosis was performed in 51.7%, while an interposition reversed saphenous vein graft was performed in 48.3%. The operative procedures were performed by an experienced vascular surgeon and well-trained pediatric surgeons and general surgeons. Pseudoaneurysms was recorded in 9% of cases. Fasciotomy was performed in 15% of cases. Conclusion: Treatment of pediatric and adolescent extremity arterial injuries with primary end-to-end vascular anastomoses or with the use of an interposition reversed saphenous vein graft is a reliable, feasible, and more cost-effectiveness technique with good results. Moreover, it should be adopted for all vascular trauma patients, whenever possible.