Pediatric peripheral vascular injuries: a review of our experience.

BACKGROUND

This study evaluated peripheral vascular injuries in a pediatric trauma population to identify injury patterns, to identify diagnostic and therapeutic modalities used, and to understand the role of pediatric surgical subspecialists.

METHODS

A retrospective review of children treated for trauma between 2000 and 2006 at a Level I Pediatric Trauma Center was performed. Patients with vascular injury were identified through an institutional trauma registry.

RESULTS

There were 42 vascular injuries identified during the study period. The average age was 9.8 years, with 64% occurring in males. The mechanism of injury was almost equally distributed between penetrating (55%) and blunt (45%) trauma. Forty-eight percent of patients had an associated fracture. Seventeen diagnostic angiograms were performed. Ninety-eight percent of patients were taken to the operating room for definitive management of one or more of their trauma injuries. Sixty-seven percent underwent operative management specifically for their vascular injury. Twenty-six percent of patients were diagnosed with vasospasm, and all were conservatively managed. Of the 42 patients, 23% were managed by pediatric surgeons, 43% by extremity specialists (orthopedic or plastic surgeons), and 29% by adult vascular surgeons.

CONCLUSIONS

Pediatric traumatic vascular injuries are associated with a higher rate of penetrating trauma than other pediatric trauma and have a relatively high rate of operative intervention. Diagnosis and treatment of pediatric vascular injuries can be made difficult by a high rate of vasospasm. Additionally, traumatic vascular injuries in the pediatric population present a unique challenge in the overlap of their management by many different surgical subspecialists.