Related Experiment Videos
Arterial trauma in children: diagnosis and management
W E Evans1, D R King, J P Hayes
1Department of Surgery, Ohio State University School of Medicine, Columbus.
Insights
Early diagnosis and arteriography are crucial for pediatric arterial injuries, especially those near the knee or elbow. Prompt treatment significantly improves functional outcomes in young trauma patients.
Area of Science:
- Pediatric Surgery
- Trauma Care
- Vascular Surgery
Background:
- Arterial injuries in children are uncommon but can lead to severe complications.
- Associated nerve and orthopedic injuries are frequent in pediatric arterial trauma.
Purpose of the Study:
- To evaluate the outcomes of surgical treatment for arterial injuries in children.
- To identify factors influencing functional results in pediatric arterial trauma.
Main Methods:
- Retrospective study of 92 children with arterial injuries over 14 years.
- Analysis of diagnostic methods, treatment strategies, and functional outcomes.
- Surgical interventions included debridement, anastomosis, ligation, thrombectomy, and bypass grafting.
Main Results:
- 76% of patients received treatment within six hours; 24% experienced delays.
- Arteriography was performed in 21% of cases, often with delays.
- Good functional results were achieved in 83 patients; six had poor outcomes, with four linked to delayed diagnosis near joints.
Conclusions:
- Early diagnosis of pediatric arterial injuries is critical for optimal outcomes.
- Liberal use of arteriography is recommended for suspected arterial trauma in children.
- Particular attention should be given to fractures around the knee and elbow due to higher risk of delayed diagnosis and poor results.
Abstract:
Ninety-two children with arterial injuries were studied over a 14 year period, 66 boys and 26 girls, whose ages ranged from 14 months to 18 years. Thirty-eight children had associated nerve injuries and 21 had orthopedic injuries as well. Interval between initial evaluation and diagnosis of arterial injury ranged from immediate to six months--76% were treated within six hours of injury and 24% had a delay of greater than six hours before diagnosis. Arteriograms were performed on 20 (21%) of the children, and 13 of these were done late. Surgical treatment consisted of local debridement and end-to-end anastomosis, ligation, exploration with thrombectomy of distal branches, or bypass grafting with vein. Three children died in the immediate postoperative period, 83 had good functional results, and six had poor functional results. Four of these six had a delayed diagnosis of arterial injury, and had injuries in arteries adjacent to the elbow or knee. We conclude that early diagnosis of arterial injury and a more liberal use of arteriography is warranted in young trauma victims, especially in cases of fractures about the knee or elbow.