Pediatric peripheral vascular surgical interventions: a 13-year single-center experience

Pediatric peripheral vascular surgical pathology is uncommon, and published experience remains limited to small institutional series or trauma-focused cohorts. We aimed to evaluate the indications, anatomic distribution, operative strategies, and 30-day outcomes of pediatric peripheral vascular surgical interventions performed at our center over a 13-year period.

This retrospective single-center cohort study included all consecutive patients younger than 18 years who underwent peripheral vascular surgical intervention between January 2012 and December 2024 at a tertiary pediatric cardiovascular referral center. Demographic characteristics, etiology, anatomic site, type of vascular involvement, operative techniques, and early outcomes were analyzed. Patients were stratified into 3 age groups: infants (0-2 years), children (3-12 years), and adolescents (> 12 to < 18 years).

A total of 60 patients were included: 14 infants (23.3%), 16 children (26.7%), and 30 adolescents (50.0%). Trauma was the most common etiology overall (36/60, 60.0%), followed by iatrogenic lesions (18/60, 30.0%) and congenital vascular lesions (6/60, 10.0%). Marked age-related differences were observed: infants were predominantly affected by iatrogenic lesions (12/14, 85.7%), whereas trauma predominated in adolescents (27/30, 90.0%). The upper extremity was the most frequently involved anatomic region overall (37/60, 61.7%), followed by the lower extremity (21/60, 35.0%) and cervical vessels (2/60, 3.3%). Arterial lesions were most common (40/60, 66.7%). The most frequently performed procedures were primary repair or end-to-end anastomosis (23/60, 38.3%), embolectomy (12/60, 20.0%), ligation (10/60, 16.7%), and autologous saphenous vein interposition grafting (8/60, 13.3%). All patients completed the 30-day clinical and Doppler ultrasonographic assessment. There was no 30-day mortality, major amputation, vascular reintervention, or clinically evident ischemic complication.

In this surgically selected cohort, favorable 30-day outcomes were observed following pediatric peripheral vascular surgical interventions, with no mortality, major amputation, or clinically evident ischemic complication. Etiologic patterns differed descriptively across age groups: trauma predominated overall and among adolescents, whereas iatrogenic lesions were most frequent among patients aged 0-2 years. These findings may support age-specific clinical awareness, individualized decision-making, and timely referral to specialized multidisciplinary centers. Multicenter studies with standardized long-term follow-up are needed to assess late vascular patency, growth-related changes in vascular reconstructions, and functional outcomes.