Surgical intervention in vascular trauma in children

Vascular trauma is uncommon in children but may be complex. Arterial injury in children presents a challenge to the surgeon and may have long-term implications. Children have major advantage of a rich-collateral circulation but are still growing and developing. Decisions about when to operate remain an issue.

Patients (<13 years) with vascular injury requiring surgical intervention were retrospectively reviewed from a trauma database of 446 trauma patients admitted to the Tygerberg Children's Hospital. Demographic data, and factors influencing the outcome were studied, as well as different modalities of management.

We reviewed a total of 20 children where surgical intervention for vascular trauma was required. Six resulted from penetrating injuries (two gunshots), ten followed blunt trauma (two popliteal extension injuries), one degloving injury, two presented later with arterio-venous fistulae. Haemorrhage from the wound in one haemophiliac patient made urgent surgery mandatory. One patient with a gunshot damage of the vertebral artery was successfully managed by radiological embolism (coils). Outcome was variable and long-term limb maldevelopment occurred in one patient.

Vascular injuries may be difficult to manage in childhood due to their complexity. Growth and developmental considerations must be borne in mind during treatment.