Arterial trauma in children: diagnosis and management.

Ninety-two children with arterial injuries were studied over a 14 year period, 66 boys and 26 girls, whose ages ranged from 14 months to 18 years. Thirty-eight children had associated nerve injuries and 21 had orthopedic injuries as well. Interval between initial evaluation and diagnosis of arterial injury ranged from immediate to six months--76% were treated within six hours of injury and 24% had a delay of greater than six hours before diagnosis. Arteriograms were performed on 20 (21%) of the children, and 13 of these were done late. Surgical treatment consisted of local debridement and end-to-end anastomosis, ligation, exploration with thrombectomy of distal branches, or bypass grafting with vein. Three children died in the immediate postoperative period, 83 had good functional results, and six had poor functional results. Four of these six had a delayed diagnosis of arterial injury, and had injuries in arteries adjacent to the elbow or knee. We conclude that early diagnosis of arterial injury and a more liberal use of arteriography is warranted in young trauma victims, especially in cases of fractures about the knee or elbow.