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Blunt pediatric vascular trauma: analysis of forty-one consecutive patients undergoing operative intervention
Y J Fayiga1, R J Valentine, S I Myers
1Department of Surgery, University of Texas Southwestern Medical Center, Dallas 75235.
Insights
Blunt vascular trauma in children is rare. While arterial injuries are recognized and treatable, abdominal venous injuries are often missed and highly lethal, posing a significant risk.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Vascular Surgery
Background:
- Blunt vascular trauma is infrequent in pediatric patients.
- Understanding its impact on mortality and morbidity is crucial.
Purpose of the Study:
- To determine the contribution of blunt vascular trauma to death and disability in children.
- To analyze the outcomes of pediatric blunt vascular injuries.
Main Methods:
- Retrospective review of medical records for 41 pediatric patients (≤17 years).
- Analysis of 48 blunt vascular injuries over an 18-year period.
- Inclusion criteria: operative intervention for blunt vascular injury.
Main Results:
- Eight patients had arterial injuries (brachial, femoral) associated with orthopedic trauma; all recognized and repaired without late sequelae.
- 33 patients sustained vascular trauma from motor vehicle crashes, pedestrian accidents, or crush injuries.
- 17 patients had 21 major abdominal venous injuries, lethal in 11 (65%), often unrecognized before laparotomy.
Conclusions:
- Blunt arterial injuries in children are rare, easily treated, and have minimal long-term effects.
- Blunt abdominal venous injuries are rarely diagnosed preoperatively and are associated with a high mortality rate (>50%).
- Venous injuries are more prevalent and devastating than arterial injuries following pediatric blunt abdominal trauma.
Purpose:
The purpose of this study was to determine the contribution of blunt vascular trauma to death and disability in children.
Methods:
We reviewed the medical records of 41 patients aged 17 years and younger requiring operative intervention for 48 blunt vascular injuries during the past 18 years.
Results:
Eight patients had arterial injuries (seven brachial, one superficial femoral) associated with orthopedic trauma resulting from falls. All eight were associated with a pulse deficit and were easily recognized. None of the eight had late sequelae after vascular repair. Thirty-three patients had vascular trauma as a result of motor vehicle crashes (n = 17), motor vehicle/pedestrian accidents (n = 12), or severe crush injuries (n = 4). Twenty-one (64%) were admitted in shock. Twenty-one major abdominal venous injuries were present in 17 patients and were lethal in 11 (65%). Abdominal venous injuries were not recognized before laparotomy. Nine of the 33 (27%) patients had extremity vascular injuries associated with orthopedic trauma, and three (9%) had major injuries of thoracic vessels. Only three patients had major abdominal arterial injuries in this series.
Conclusions:
Vascular injuries resulting from blunt trauma are rare in the pediatric age group. Whereas blunt arterial injuries associated with long bone fractures are readily recognized, easily treated, and result in minimal late morbidity, blunt abdominal venous injuries are rarely recognized before exploration and are lethal in more than half. Devastating venous injuries are more common than arterial injuries after blunt abdominal trauma in children.