Inpatient pediatric clinical consultations to vascular surgery within a children's hospital

Acute pediatric vascular issues are infrequent and result in a diverse, unpredictable experience for vascular surgeons and trainees. We reviewed the indications for consult and resulting interventions provided by the Vascular Surgery (VS) service at a freestanding Children's Hospital (CH) adjacent to a university hospital.

Consults to VS at our CH were reviewed over a 4.5-year period. The acuity of the patient, nature of the disease (arterial, venous, and other), and etiology were documented. Treatments resulting from consultation (medical therapy, observation, or intervention - open/endovascular), and patient outcomes were documented.

One hundred consults to VS occurred. Average patient age was 8.5 years (range, 1 day to 18 years). Ninety consults were for acute conditions. Pathology included arterial (n = 64), venous (n = 20), and other (n = 16). Primary etiologies were iatrogenic injury (n = 40) and trauma (n = 31). Nearly two-thirds of patients were in the intensive care unit (n = 66), and one-third of intensive care unit consults were for children <1 year old. Medical management alone was utilized in 46 cases: 65% receiving anticoagulation, 13% ASA, 9% blood pressure control, 4% antibiotics, and 9% other. In 37 cases, no interventions for the vascular query were needed. Overall, 17 consults resulted in 19 surgical interventions (5 bypass/interposition/patch, 4 primary vascular repairs, 3 fasciotomies, 2 angiograms, 2 embolectomies, 1 amputation, 1 thoracic endograft, 1 first rib resection). The one early graft failure required revision. No operative interventions were performed in children <3 years old. Of 17 deaths, none were due to vascular injury.

Consults to VS in a CH are infrequent and encompass a wide breadth of vascular disease. In contrast to the adult population, medical therapies are frequently utilized, whereas a minority undergo open or endovascular interventions. At 20 consults per year, a typical trainee may be involved in 40 to 60 pediatric cases during their residency. Exposure to the pediatric population is a small but important niche in vascular education and practice.