Pediatric vascular injuries

The literature on the treatment of pediatric vascular injuries was reviewed. Aggressive treatment of arterial ischemia is clearly indicated, since children with uncorrelated arterial thrombosis are almost certain to develop a growth abnormality in the affected extremity. Alternatives to operative treatment have not been well described. Operative treatment is technically difficult and results are strongly influenced by age. To emphasize this relationship, we combined 10 cases of arterial thrombosis treated operatively in children under age 2 years complied form the literature with five similar cases reviewed retrospectively in our hospital. In these 15 patients the etiology was iatrogenic in 100%. Sixty-seven percent (10 of 15) were treated with simple thrombectomy, and only one patient (7%) received a graft. At up to 8 years of follow-up, only 26% (3 of 15) were normal, 47% (7 of 15) had thrombosis, 20% (3 of 15) had suffered tissue loss, and there had been one perioperative death. We conclude that operative treatment of an ischemic although viable limb in a small child might best be deferred if simple thrombectomy has failed or if a more complex procedure would be required at the outset, with the hope that any growth abnormality that developed could be reversed by definitive reconstruction when the child is larger.