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Published on: December 31, 2017
Vascular injuries in the young
Jeremy W Cannon1, Michael A Peck
1Brooke Army Medical Center, San Antonio, TX 78234, USA. jcannon@massmed.org
Insights
Pediatric vascular injuries from trauma or procedures are complex. Current trends favor operative exploration and repair, moving beyond older methods like ligation.
Area of Science:
- Pediatric vascular surgery
- Trauma surgery
- Vascular medicine
Background:
- Vascular injuries in children stem from invasive procedures, penetrating trauma, and blunt trauma.
- Management approaches vary among subspecialists with limited literature guidance.
- Recent trends suggest more aggressive operative strategies for pediatric vascular injuries.
Purpose of the Study:
- To review the scope of iatrogenic and traumatic vascular injuries in children.
- To summarize historical and current literature on pediatric vascular injury diagnosis and management.
- To discuss evolving treatment strategies and future research directions.
Main Methods:
- Comprehensive literature review of pediatric vascular injuries.
- Analysis of historical and contemporary treatment approaches.
- Examination of diagnostic and interventional techniques.
Main Results:
- Shift from ligation/heparinization to operative exploration and repair.
- Increasing use of endovascular techniques for diagnosis and intervention.
- Need for evidence-based guidelines for pediatric vascular trauma.
Conclusions:
- Pediatric vascular injuries require specialized management, with a trend towards aggressive surgical repair.
- Endovascular interventions offer new diagnostic and therapeutic options.
- Multidisciplinary collaboration is crucial for advancing research and optimizing care.
Abstract:
Vascular injuries in children result from invasive procedures, penetrating trauma, and blunt injuries. Depending on local practice patterns, these injuries are managed by a range of subspecialists with little guidance from the literature on the optimal approach to diagnosis and management of these challenging injuries. Recently, more aggressive operative approaches to managing injuries in the young have been advocated and have been supported by recent reports from several series of wartime vascular injuries involving children. This review summarizes the scope of both iatrogenic and traumatic vascular injuries and the historic and current literature on these topics. Treatment strategies are also reviewed placing emphasis on the transition from ligation or heparinization to the current trend of managing suspected vascular injuries with operative exploration and repair, including, in some instances, endovascular diagnosis and intervention. Future directions for clinical research in this area are also discussed, which will hopefully promote more multidisciplinary collaboration in this area.
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