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Paediatric arterial injury: management options at the time of injury
Insights
Arterial injuries in children are challenging. Blunt trauma often causes arterial spasm, potentially avoiding surgery with imaging, while penetrating injuries typically require immediate surgical repair.
Area of Science:
- Pediatric vascular surgery
- Trauma surgery
Background:
- Arterial injury in children poses significant challenges for vascular surgeons.
- Established management guidelines require evaluation through clinical data analysis.
Purpose of the Study:
- To evaluate established management guidelines for pediatric arterial injuries.
- To analyze the outcomes of surgical and non-surgical interventions for arterial trauma in children under 12.
Main Methods:
- Retrospective review of clinical records for 40 pediatric patients (under 12 years) with arterial injuries over a 4-year period.
- Categorization of injuries into blunt (29 cases) and penetrating (11 cases).
- Analysis of treatment strategies including surgical repair, vein grafting, and non-operative management.
Main Results:
- Arterial spasm was identified as a key factor in blunt trauma cases, with 14 of 29 patients not requiring repair.
- Intravenous digital subtraction angiography may help avert surgery in some blunt trauma cases.
- Penetrating injuries predominantly necessitated urgent surgical intervention due to hemorrhage.
Conclusions:
- Arterial spasm is a significant consideration in pediatric blunt arterial trauma.
- Vascular exploration is crucial when limb viability is uncertain.
- Accurate diagnosis and tailored treatment are essential for managing pediatric arterial injuries.
Abstract:
Arterial injury in children presents a challenge, even to the experienced vascular surgeon. In order to evaluate established management guidelines, the clinical records of all patients under 12 years of age presenting with arterial injury were studied. Over a 4-year period, a total of 40 patients were treated; 29 after blunt trauma, and 11 with penetrating injuries. Upper limb vessels were involved in 17 cases, lower limb in 20, renal in two and facial in one. In most patients with penetrating injury, haemorrhage from the wound made urgent surgery mandatory. In the 29 patients who had sustained blunt injury and were submitted to operation, no repair was necessary in 14. The clinical signs of absent pulses were due to spasm. Thirteen required reverse vein graft, and in two no repair was attempted: in one patient the renal artery was ligated, and in the other ischaemic forearm muscles precluded any recovery. In those children referred for vascular opinion, it would appear that arterial spasm is an important problem after blunt trauma. In this subgroup, operation may be averted in some patients with the use of intravenous digital subtraction angiography. Exploration is mandatory if there is any doubt about the limb viability.