Traumatic avulsion of arch vessels in a child: primary repair using hypothermic circulatory arrest (case report)

Area of Science:

• Vascular Surgery
• Pediatric Trauma
• Cardiopulmonary Bypass

Background:

• Arterial avulsion, particularly of major vessels like the carotid and subclavian arteries, is a rare and life-threatening injury in pediatric trauma.
• Management often requires complex surgical intervention, potentially involving vascular grafts.

Observation:

• A 7-year-old girl ejected from a speeding motor vehicle presented with avulsion of the left carotid and left subclavian arteries.
• The injury posed a significant risk of hemorrhage and neurological compromise.

Findings:

• Surgical repair of the avulsed left carotid and left subclavian arteries was successfully performed.
• The repair was achieved primarily without the need for graft material.
• Cerebral protection strategies, including cardiopulmonary bypass, profound hypothermia, and circulatory arrest, were utilized during the procedure.

Implications:

• This case demonstrates the feasibility of primary arterial repair in severe pediatric vascular trauma.
• The successful application of cardiopulmonary bypass, profound hypothermia, and circulatory arrest highlights their role in managing complex vascular injuries.
• This approach may offer an alternative to grafting, potentially reducing complications and improving outcomes in similar pediatric cases.