Pediatric vascular trauma: diagnosis management, and outcome

ABSTRACT

Although vascular injury is relatively infrequent, it contributes to significant morbidity and mortality. Because pediatric vascular injury is not uncommon during childhood and adolescence, surgical management has traditionally been based on adult trauma experience. This report examines the causes, mechanisms of injury, associated trauma, and results of treatment of pediatric patients with vascular injuries. Fifteen children with 13 arterial and 2 venous injuries were included in the study. There were 9 boys and 6 girls with a mean age of 63 months [range; 1day-13 years]. Sixty percent of children were in preschool age [6 years]. The mechanism of injury was penetrating trauma in 6 patients, blunt trauma in 4, and iatrogenic trauma in 5. Vascular injuries were divided between the upper extremity [7], lower extremity [6], neck [1], and abdomen [1]. Open surgery was the method of treatment in 12 children, Medical treatment consisting of systemic heparin administration was offered in 3 children. Vascular repair was attempted in 5 preschool and in 4 older children. The vessels were ligated in 3 children. There were 3 deaths, all of which occurred in the nonoperative group due to other causes. One patient, in the surgical arm, underwent a below-knee amputation. Overall, the outcome was good in 73.3% [11/15] cases [9 1.7% among surviving patients]. The results of the present study allow us to conclude that an aggressive approach, with early intervention and reconstructive techniques, allows successful management of most of pediatric vascular injuries