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A surgical approach to iatrogenic vascular injuries in pediatric cases
Yüksel Beşir1, Orhan Gökalp, Börteçin Eygi
1Department of Cardiovascular Surgery, İzmir Katip Çelebi University Faculty of Medicine, İzmir-Turkey. yukselbesir@hotmail.com.
Insights
Pediatric vascular injuries, often from interventional procedures, are successfully treated with surgical repair. This study highlights the safety and effectiveness of these interventions in young patients.
Area of Science:
- Pediatric Surgery
- Vascular Surgery
- Interventional Radiology
Background:
- Surgical intervention is crucial for managing vascular trauma in children.
- Complicated cases following medical interventions often necessitate surgical repair.
- This study analyzes surgical interventions for pediatric vascular injuries.
Purpose of the Study:
- To analyze surgical interventions for vascular injuries in pediatric patients.
- To evaluate the outcomes of surgical repairs for iatrogenic vascular injuries.
- To identify the primary causes and locations of vascular injuries in children.
Main Methods:
- Retrospective analysis of 17 pediatric patients (under 18) with vascular injuries admitted between 2002-2012.
- Data collected from hospital records, including preoperative and postoperative details.
- Evaluation of injury types, locations, anesthesia, repair methods, and patient outcomes.
Main Results:
- Most injuries (82.3%) resulted from angiographic interventions, predominantly in the femoral artery (64.7%).
- Surgical repair involved primary sutures (88.2%) or anastomosis, with thrombectomy performed in 94.1% of cases.
- Excellent outcomes were observed, with no mortality, limb loss, or infection, and short hospital (2.7±1.4 days) and ICU (1.1±0.4 days) stays.
Conclusions:
- Iatrogenic causes, particularly from interventional procedures, are the leading source of pediatric vascular injuries.
- Surgical repair of these injuries in children demonstrates high success rates and efficiency.
- The study confirms the safety and effectiveness of surgical management for pediatric vascular trauma.
Background:
Surgical intervention is mandatory in many children who present with vascular trauma or in complicated cases after medical interventions. In this study, surgical interventions applied after vascular injuries in children were analyzed.
Methods:
Between January 2002 and December 2012, 17 patients (aged under 18) who were admitted to the emergency room with vascular injuries were retrospectively analyzed. The data was collected through hospital records. Preoperative and postoperative data of the patients were recorded and analyzed.
Results:
Of the total, 11 patients were female (64.7%) and 6 patients were male (35.3%) with a range of 4-192 months. In total, 14 (82.3%) injuries were due to angiographic interventions, 1 (5.9%) was due to external trauma, 1 (5.9%) was due to preoperative trauma, and 1 (5.9%) was due to a catheterization complication in the intensive care unit. Additionally, 11 (64.7%) injuries were located in the right femoral artery, 3 (17.6%) were located in the left femoral artery, 2 (11.8%) were located in the left brachial artery, and 1 (5.9%) was located in the left external iliac vein. Also, 5 (29.4%) patients were managed under local anesthesia and 12 (70.6%) patients were managed under general anesthesia. With respect to treatment, 15 (88.2%) injuries were repaired with primary sutures, 1 (5.9%) injury was repaired with an end-to-end anastomosis, and 1 (5.9%) injury was repaired with a saphenous vein graft interposition. In addition, 16 (94.1%) patients underwent a thrombectomy prior to the repair. The total hospital stay was calculated as 2.7±1.4 days. The intensive care unit stay was calculated as 1.1±0.4 days. There was no mortality, a loss of an injured extremity, or an infection. No other complication was detected.
Conclusion:
Iatrogenic interventional procedures seem to be responsible for the majority of pediatric vascular injuries. The results of surgical repairs in these injuries are successful and efficient.
