Management and outcome of pediatric vascular injuries

BACKGROUND Vascular injuries in children are relatively uncommon. The objective of this population-based study was to investigate the epidemiology, management, and early outcomes of pediatric vascular injuries. METHODS A nationwide survey of prospectively collected data on pediatric vascular injuries in children 15 years or younger between 1987 and 2013 was conducted. Data were retrieved from the National Vascular Surgery registry (Swedvasc) and cross-matched with the National Population Register for mortality data. Demographics, operative techniques, and outcomes were analyzed. RESULTS There were 222 children (boys, n = 148; girls, n = 74) included in this study, with a mean (SD) age of 9.6 (4.1) years (range, 0.5-15 years; <6 years, 18 %; 6-10 years, 39%; >10 years, 42%). Blunt trauma mechanism (n = 146, 66%) was dominant, followed by penetrating (n = 51, 23%) and iatrogenic trauma (n = 21, 9%). Anatomic locations of vascular injuries were primarily upper extremities (n = 134, 60%) and lower extremities (n = 65, 29%), followed by the abdomen (n = 16, 7.2%). Upper extremity injuries were most common in the age group of 10 years or younger (78%, 100 of 128), and lower extremity injuries were most common in the age group of 11 years to 15 years (48%, 45 of 94). Major repair techniques included interposition graft (n = 54, 24%), patch (n = 43, 19%), primary repair (lateral suture/direct anastomosis) (n = 27, 12%), bypass (n = 21, 9.5%), and endovascular techniques (n = 8, 3.7%). Exploration or release of artery was performed in 51 cases (23%). Vein (n = 110) was the dominant graft material, and synthetic grafts (polytetrafluoroethylene/dacron) were only used in four open cases. The most common postoperative complication was arterial occlusion/thrombosis (n = 12). At 30-day follow-up, there was one above-knee and two below-knee amputations as well as one death. No more deaths at 1-year follow-up did occur. CONCLUSION This nationwide population-based study shows that traumatic vascular injuries in children are associated with high limb salvage rates and low mortality. Blunt trauma mechanism is dominant, and injuries are primarily located to the upper and lower extremities. The preferred repair techniques are venous patch angioplasty and interposition graft, and the frequency of endovascular repair is still low. LEVEL OF EVIDENCE Epidemiologic study, level III.