Zentralblatt fur Chirurgie · 2025
[Vascularsurgical Care in Childhood].
СтатьяОбзорАннотация на английскомНазвание и аннотация: Перевод пока не подготовлен
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Arndt Stephan, Barth Udo, Turial Salmai, March Christine, Pech Maciej, Meyer Frank, Halloul Zuhir
Аннотация
AIM: Based on i) selective references from the medical scientific literature and ii) our own clinical and interdisciplinary management experiences from daily practice, vascular surgical care of vascular alterations in childhood, in particular, in trauma-associated injuries, will be illustrated.
METHOD: Narrative review by means of a literature search in PubMed using the key words "vascular surgery", "childhood", "vascular injury" and "vascular intervention".
RESULTS (CRUCIAL POINTS): The development of the vascular system is a complex process, during which neoformation and degeneration processes proceed, closely associated to genetic factors, as well as to achieve complete maturation by epigenetic factors, but only at the age of approximately 16 years, which has to be included in the consideration of vascular diseases in children and their treatment concepts.The relatively rarely occurring vascular surgical diseases and the specifics of the young patient clientele demand the highest measure of vascular medical expertise in both clinical examination (e.g., marfanoid habitus, extremity-dependent blood pressure levels in aortic stenosis, unspecific symptoms of arterial hypertension in renal artery stenoses) and instrument-based diagnostics, such as Duplex ultrasonography.Suitable autologous material for artery replacement with proper quality and quantity is only scarcely available, resulting so that i) endovascular therapeutic concepts (e.g., angioplastic "bridging" procedures or usage of re-dilating stents in definitive intention, in particular, in aortic diseases) become increasingly more important and ii) xenogenic material taps new fields for vascular substitution, in addition to "tissue engineering" in this specific patient clientele and disease profile.
CONCLUSION: The specific patient clientele and disease profile emphasise the necessity of i) a highly specialised interdisciplinary team comprising paediatricians, radiologists, vascular and paediatric surgeons as well as ii) the great value of a sufficient physical examination using Duplex ultrasonography primarily - but also provide immediate access to angiographic diagnostics and therapeutic procedures (adapted to the specific age) as it can only be done in centres of highly specialised care.
METHOD: Narrative review by means of a literature search in PubMed using the key words "vascular surgery", "childhood", "vascular injury" and "vascular intervention".
RESULTS (CRUCIAL POINTS): The development of the vascular system is a complex process, during which neoformation and degeneration processes proceed, closely associated to genetic factors, as well as to achieve complete maturation by epigenetic factors, but only at the age of approximately 16 years, which has to be included in the consideration of vascular diseases in children and their treatment concepts.The relatively rarely occurring vascular surgical diseases and the specifics of the young patient clientele demand the highest measure of vascular medical expertise in both clinical examination (e.g., marfanoid habitus, extremity-dependent blood pressure levels in aortic stenosis, unspecific symptoms of arterial hypertension in renal artery stenoses) and instrument-based diagnostics, such as Duplex ultrasonography.Suitable autologous material for artery replacement with proper quality and quantity is only scarcely available, resulting so that i) endovascular therapeutic concepts (e.g., angioplastic "bridging" procedures or usage of re-dilating stents in definitive intention, in particular, in aortic diseases) become increasingly more important and ii) xenogenic material taps new fields for vascular substitution, in addition to "tissue engineering" in this specific patient clientele and disease profile.
CONCLUSION: The specific patient clientele and disease profile emphasise the necessity of i) a highly specialised interdisciplinary team comprising paediatricians, radiologists, vascular and paediatric surgeons as well as ii) the great value of a sufficient physical examination using Duplex ultrasonography primarily - but also provide immediate access to angiographic diagnostics and therapeutic procedures (adapted to the specific age) as it can only be done in centres of highly specialised care.