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Peripheral arterial trauma in children. A fifteen year review
Insights
Peripheral vascular trauma in children, often iatrogenic, requires surgical repair. Younger children and those under 12.5 kg had lower success rates for restoring blood flow.
Area of Science:
- Pediatric Surgery
- Vascular Surgery
- Trauma Management
Background:
- Peripheral vascular trauma is a significant concern in pediatric patients.
- Understanding injury patterns and outcomes is crucial for effective treatment.
- Iatrogenic injuries represent a major cause of vascular trauma in this age group.
Purpose of the Study:
- To evaluate the outcomes of peripheral vascular trauma in infants and children.
- To identify factors influencing the success of vascular reconstruction.
- To analyze different surgical techniques for repairing arterial injuries.
Main Methods:
- A 15-year retrospective review of pediatric patients with peripheral arterial injuries.
- Analysis of 48 affected limbs in 47 patients, focusing on injury type, surgical repair, and outcomes.
- Categorization of injuries into iatrogenic, penetrating, and blunt trauma.
Main Results:
- Iatrogenic injuries were the most common (40/48 limbs).
- Successful circulation restoration was achieved in 77.8% (35/45 limbs) post-surgery.
- Lower patency rates were observed in iatrogenic injuries among patients under three years or weighing less than 12.5 kg (p < 0.05).
Conclusions:
- Surgical repair of pediatric peripheral vascular trauma can restore circulation effectively.
- Younger children and lower-weight infants with iatrogenic injuries face poorer outcomes.
- Further research into optimizing surgical strategies for high-risk pediatric populations is warranted.
Abstract:
A 15 year retrospective evaluation of peripheral vascular trauma in infants and children was undertaken. Forty-eight affected limbs in 47 patients (mean age 5.1 years) were explored for peripheral arterial injury. There were 40 iatrogenic, five penetrating and three blunt injuries. Thrombectomy alone, thrombectomy with autogenous saphenous vein patch angioplasty, direct angioplasty, segmental resection with end-to-end anastomosis and interposition-bypass grafting were the most common reparative procedures used. Circulation was normal within 24 hours of surgery in 35 of the 45 limbs (77.8%) whose patency was restored. In patients less than three years or 12.5 kg with iatrogenic injuries, patency rate was significantly lower (p 0.05). Four children died of congenital heart disease. All six children with failed vascular reconstruction suffered late sequelae.