Stent It and Forget It? Not in Kids: Endovascular Treatment of Traumatic Arterial Injuries in Adolescents

Repair strategies for pediatric vascular injuries must consider vascular growth and intervention durability. Endovascular interventions are increasingly utilized in pediatrics, particularly in unstable patients or for injuries in surgically morbid regions. This study describes a single-center experience with endovascular stenting in adolescent pediatric trauma.

A mixed prospective/retrospective study of patients (<18 years) who underwent endovascular stent-grafting for traumatic arterial injuries at a Level 1 trauma center (2011-2024) was performed. Demographics, injury characteristics, operative details, postoperative course, anticoagulation, and follow-up were collected.

Eighteen patients underwent endovascular stenting (median age 15.7 years (range 14.1-17.9); median weight 65.7 kg (range 45.6-99.2)). Median injury severity score was 38 (IQR 17-41). Injuries were blunt in 67% and penetrating in 33%. Stents were used exclusively for aorta (10) or axillosubclavian injuries (7). Four patients (23.5%) had early complications requiring reintervention; one died secondary to comorbid injuries. Fifteen patients (83%) were successfully treated with stenting, without death or limb loss, at discharge. Antiplatelet therapy was prescribed in 76% of patients, with one bleeding complication. Two late complications were identified and required intervention. 86% (6/7) of the patients contacted prospectively were asymptomatic (median follow-up time of 7.0 years (IQR 4.3-12.6)).

Endovascular stenting is a valuable and potentially lifesaving alternative in adolescents with aortic or axillosubclavian traumatic injury, especially when the morbidity of an open repair is prohibitive. Complications occur frequently, and current vascular surgery recommendations are for lifelong surveillance, highlighting the need for robust follow-up systems.