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Vascular trauma in infants and children
Insights
Pediatric vascular trauma, including arterial and venous injuries, can be successfully managed with prompt surgical intervention. Early diagnosis and treatment significantly improve outcomes, avoiding major amputations in children.
Area of Science:
- Pediatric Surgery
- Vascular Surgery
- Trauma Surgery
Background:
- Vascular trauma in infants and children is a rare but serious condition.
- Retrospective analysis of pediatric vascular injuries is crucial for understanding management strategies.
Purpose of the Study:
- To evaluate the outcomes of surgical management for vascular trauma in pediatric patients.
- To identify key factors for successful treatment of vascular injuries in children.
Main Methods:
- Retrospective review of 53 pediatric cases with blunt or penetrating vascular trauma over 20 years.
- Inclusion criteria: patients presenting with signs of vascular injury near major vessels.
- Diagnostic methods included arteriography and operative exploration; all patients underwent surgery.
Main Results:
- The brachial artery and superficial femoral artery were the most common arterial injury sites; the inferior vena cava was the most common venous site.
- 41 major arterial and 32 major venous injuries were identified; no patient required amputation.
- Operative mortality was 13%, primarily due to exsanguinating hemorrhage.
Conclusions:
- A high index of suspicion, aggressive diagnostic workup, and prompt surgical intervention are essential for managing pediatric vascular trauma.
- Surgical repair techniques included primary closure, resection with anastomosis, and use of grafts/conduits.
- Effective management can prevent severe complications like amputation in pediatric patients.
Abstract:
A 20-year retrospective evaluation of vascular trauma in infants and children was undertaken. The study included 53 cases of blunt and penetrating vascular injuries in pediatric patients. There were 36 males and 17 females ranging in age from 24 days to 14 years (average, 10 years). The most frequently encountered sites of arterial trauma were the brachial or superficial femoral artery, and of venous trauma the inferior vena cava. Any patient presenting to the Emergency Center with an injury in proximity to a major vessel, hematoma formation, audible bruit, or palpable thrill underwent prompt arteriography or immediate operative exploration of the injury sit. All patients in the series were managed operatively. There were 41 major arterial and 32 major venous injuries. No patient required a major amputation. Most injuries were repaired by primary closure or segmental resection and end-to-end anastomosis; interposition vein grafts and substitute conduits were used in four patients with more extensive injuries. A 13% operative mortality was encountered: the most frequent cause of death was intraoperative exsanguinating hemorrhage. The triad for successful management of vascular trauma in pediatric patients is: 1) a high index of suspicion, 2) performance of aggressive diagnostic studies when indicated, and 3) prompt surgical intervention.