Real-World Spectrum of Pediatric Referrals to a Tertiary Angiology and Vascular Surgery Center: Classification,...

To characterize the real-world spectrum of children referred to a tertiary vascular surgery clinic for suspected vascular disease, including referrals not fully classifiable within International Society for the Study of Vascular Anomalies (ISSVA) at first assessment, and to describe imaging use, management, and follow-up.

We performed a single-center retrospective cohort study at a tertiary hospital in Northern Portugal. Patients aged <18 years referred between January 1, 2014 and November 30, 2024 were identified through vascular surgery outpatient clinic records. Demographics, referral source, presenting features, anatomic distribution, diagnostic grouping, imaging, management, and follow-up were abstracted from clinical records. Analyses were descriptive.

Of 184 administratively identified records, 182 children comprised the final cohort. Median age at referral was 6.0 years (interquartile range, 2.0-10.2), and 48.9% were female. Congenital vascular anomaly was the largest high-level diagnostic category (71/182, 39.0%), but acquired vascular disease (43/182, 23.6%), other/not classifiable diagnoses (36/182, 19.8%), and functional vascular disorders (12/182, 6.6%) were also common. ISSVA-aligned classification was possible in 72/182 (39.6%), most often vascular malformation (45/182, 24.7%). Lower-limb involvement predominated (88/182, 48.4%). Duplex ultrasound (95/182, 52.2%) and magnetic resonance imaging (MRI) (61/182, 33.5%) were the main imaging modalities, whereas computed tomography and catheter angiography were uncommon. Observation only was the most frequent management strategy (106/182, 58.2%); any medical therapy and any interventional treatment were recorded in 59/182 (32.4%) and 39/182 (21.4%), respectively.

Tertiary pediatric vascular surgery practice extends beyond ISSVA-classifiable anomalies. A pragmatic classification strategy, ultrasound- and MRI-centered imaging pathway, and selective intervention within multidisciplinary care reflects contemporary real-world tertiary practice.