Penetrating popliteal artery injuries in children

Two children, aged 8 and 12, were seen recently at the Vanderbilt University Medical Center and Metropolitan Nashville General Hospital with gunshot injury to the popliteal artery. Both patients presented with late complications following missed penetrating injury to the popliteal artery. At presentation, distal pulses were palpable despite significant proximal arterial injury. Arteriography detailed traumatic popliteal artery aneurysms in both children, and an arteriovenous fistula in one child. These two children represent the youngest patients recorded in the surgical literature with gunshot trauma to the popliteal artery, subsequent formation of traumatic aneurysms, and an arteriovenous fistula. The increasing availability of guns and rifles in the household will likely increase the incidence of such injuries to children. As evidenced by these children, palpable pulses distal to an injury do not obviate the need for arteriography when arterial injury is suspected. Autogenous repair of the injured artery or reconstruction with autogenous vein graft is preferable for repair of vascular injuries in children.