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Age-Specific Strategies in Pediatric Vascular Trauma: A Comparative Analysis of Surgical and Heparin-Based
Nikolaos Giannakopoulos1, Georgios Pitoulias2, Sofia Tzamtzidou1
1Vascular Surgery, Korgialeneio-Benakeio Hellenic Red Cross Hospital, Athens, GRC.
Insights
Pediatric vascular trauma management shows high limb salvage rates with both surgery and heparin. Age-specific protocols are crucial for optimal outcomes in children under 13.
Area of Science:
- Vascular Surgery
- Pediatric Traumatology
- Vascular Medicine
Background:
- Pediatric vascular trauma presents unique challenges, risking long-term limb compromise and growth abnormalities.
- Standardized treatment protocols are lacking for pediatric arterial injuries.
- This study evaluates heparin-based conservative versus surgical treatment in children under 13.
Purpose of the Study:
- To compare the efficacy of heparin-based conservative management with surgical interventions for pediatric vascular trauma.
- To assess outcomes in children under 13 with brachial and femoral artery injuries.
- To determine the impact of age on treatment effectiveness and limb salvage.
Main Methods:
- Retrospective observational study of 27 pediatric patients (aged ≤13) with arterial trauma (brachial/femoral).
- Injuries classified as penetrating, blunt, or iatrogenic.
- Treatment groups: open surgical repair vs. medical management with unfractionated heparin; age groups: <6 years vs. ≥6 years.
Main Results:
- Overall limb salvage rate of 87% achieved across both treatment modalities.
- One limb loss occurred in a patient under six who underwent surgery; no significant limb-length discrepancies noted.
- Surgical repair, including vein grafting, effectively restored distal pulses.
Conclusions:
- Age-specific treatment protocols are essential for managing pediatric vascular trauma.
- Individualized care, utilizing both surgical and conservative (heparin) approaches, leads to high limb salvage and favorable outcomes.
- Findings support the development of nuanced, age-tailored management strategies for pediatric vascular injuries.
Abstract:
Background Pediatric vascular trauma, although rare, poses significant clinical challenges due to the potential for long-term morbidity, including limb compromise and growth abnormalities. This study addresses the gap in standardized treatment protocols by evaluating the efficacy of heparin-based conservative treatments compared to surgical interventions in children under 13 years of age. Methods A retrospective observational study was conducted at a referral center, reviewing institutional records from January 2010 to December 2020. The study included 27 pediatric patients aged up to 13 years who sustained arterial trauma involving the brachial and femoral arteries. Injuries were categorized as penetrating, blunt, or iatrogenic. Patients were divided into two age groups: those below six years and those six years and above. Treatment modalities were categorized into open surgical repair and medical management with unfractionated heparin. The diagnosis was confirmed through physical examination, Doppler ultrasound, and angiography. Results Out of 27 patients, 17 underwent surgical intervention, while 10 received medical management with heparin. An overall limb salvage rate of 87% was achieved. One case of limb loss occurred in a patient under six years who underwent surgical intervention. No significant limb-length discrepancies were observed. Surgical approaches, particularly interposition vein grafting, effectively restored palpable distal pulses. The results highlight the importance of an age-specific approach, demonstrating the effectiveness of both surgical and conservative treatments. Conclusion The study underscores the necessity for age-specific treatment protocols in pediatric vascular trauma. Individualized care resulted in high rates of limb salvage and favorable outcomes. These findings contribute to enhancing the understanding and management of pediatric vascular trauma, promoting the development of nuanced, age-tailored treatment protocols in clinical practice.
