Major vascular injuries in the pediatric population

Ischemia requiring revascularization is rare in the pediatric population. We have evaluated the immediate and late outcomes for children undergoing peripheral bypass for ischemia secondary to trauma to both upper and lower extremities. Children requiring vascular repair with saphenous vein bypass at a pediatric hospital and trauma center over a 5-year time period were reviewed. Nineteen patients sustained major vascular injuries requiring bypass, with a mean age at time of injury of 13.9 years (5-18). Nine of the 19 patients were available for late follow-up. The mechanism of injury was evenly divided between blunt, 8, and penetrating, 11. Injuries were also relatively evenly distributed between upper, 10, and lower extremities, 9. Associated, nonvascular injuries were present in 79% of patients. There were no deaths, and 95% primary limb salvage was achieved with a multidisciplinary approach. Seventy-five percent of patients were able to resume normal activities after surgery, with a mean time of 1.5 months to full use of the affected limb. The 25% of patients with residual decreased function, despite patent bypasses, had concomitant lower extremity orthopedic injuries. A multidisciplinary approach with orthopedic, hand, and plastic surgery involvement was frequently needed. Good short-term and acceptable long-term outcomes were achieved despite significant limb injuries.