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Management and outcome of pediatric vascular injuries
Carl-Magnus Wahlgren1, Björn Kragsterman
1From the Department of Vascular Surgery/Trauma Center Karolinska (C.-M.W.), Karolinska Institutet and Karolinska University Hospital, Stockholm; and Section of Vascular Surgery (B.K.), Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Insights
Pediatric vascular injuries are most often caused by blunt trauma, primarily affecting limbs. This study found high limb salvage rates and low mortality with common repair techniques including venous grafts.
Area of Science:
- Vascular Surgery
- Pediatric Trauma
- Epidemiology
Background:
- Pediatric vascular injuries are infrequent but can lead to severe consequences.
- Understanding their epidemiology, management, and outcomes is crucial for improving care.
Purpose of the Study:
- To investigate the epidemiology, management, and early outcomes of traumatic vascular injuries in children.
- To analyze demographic data, surgical techniques, and complication rates.
Main Methods:
- A nationwide population-based study using prospectively collected data from 1987-2013.
- Data sourced from the National Vascular Surgery registry (Swedvasc) and National Population Register.
- Analysis of demographics, operative techniques, and outcomes in children aged 15 years or younger.
Main Results:
- 222 children were included; blunt trauma (66%) was the most common mechanism, predominantly affecting upper (60%) and lower extremities (29%).
- Common repair techniques included interposition grafts (24%) and patch angioplasty (19%), with limited use of endovascular methods (3.7%).
- The most frequent complication was arterial occlusion/thrombosis (12); 30-day outcomes included three amputations and one death, with no further deaths at 1-year.
Conclusions:
- Traumatic vascular injuries in children have high limb salvage rates and low mortality.
- Blunt trauma is the leading cause, with injuries concentrated in the extremities.
- Venous patch angioplasty and interposition grafts are preferred repair methods.
Background:
Vascular injuries in children are relatively uncommon. The objective of this population-based study was to investigate the epidemiology, management, and early outcomes of pediatric vascular injuries.
Methods:
A nationwide survey of prospectively collected data on pediatric vascular injuries in children 15 years or younger between 1987 and 2013 was conducted. Data were retrieved from the National Vascular Surgery registry (Swedvasc) and cross-matched with the National Population Register for mortality data. Demographics, operative techniques, and outcomes were analyzed.
Results:
There were 222 children (boys, n = 148; girls, n = 74) included in this study, with a mean (SD) age of 9.6 (4.1) years (range, 0.5-15 years; <6 years, 18 %; 6-10 years, 39%; >10 years, 42%). Blunt trauma mechanism (n = 146, 66%) was dominant, followed by penetrating (n = 51, 23%) and iatrogenic trauma (n = 21, 9%). Anatomic locations of vascular injuries were primarily upper extremities (n = 134, 60%) and lower extremities (n = 65, 29%), followed by the abdomen (n = 16, 7.2%). Upper extremity injuries were most common in the age group of 10 years or younger (78%, 100 of 128), and lower extremity injuries were most common in the age group of 11 years to 15 years (48%, 45 of 94). Major repair techniques included interposition graft (n = 54, 24%), patch (n = 43, 19%), primary repair (lateral suture/direct anastomosis) (n = 27, 12%), bypass (n = 21, 9.5%), and endovascular techniques (n = 8, 3.7%). Exploration or release of artery was performed in 51 cases (23%). Vein (n = 110) was the dominant graft material, and synthetic grafts (polytetrafluoroethylene/dacron) were only used in four open cases. The most common postoperative complication was arterial occlusion/thrombosis (n = 12). At 30-day follow-up, there was one above-knee and two below-knee amputations as well as one death. No more deaths at 1-year follow-up did occur.
Conclusion:
This nationwide population-based study shows that traumatic vascular injuries in children are associated with high limb salvage rates and low mortality. Blunt trauma mechanism is dominant, and injuries are primarily located to the upper and lower extremities. The preferred repair techniques are venous patch angioplasty and interposition graft, and the frequency of endovascular repair is still low.
Level Of Evidence:
Epidemiologic study, level III.
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