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Complexity And Variability Of Vascular Surgery In Civilian Pediatric Trauma
Misak Harutyunyan, MD, R.Clement Darling, III, MD, Casey Hladik, MD, Jeffrey Hnath, MD.
Albany Medical Center, Albany, NY, USA.
Objective: Vascular injuries in the pediatric population are rare for reasons involving limited access to motor vehicles and firearms as well as the natural pliability of younger tissues. Vascular interventions for adult trauma or for atherosclerotic indications treat larger and more mature tissues and include endovascular therapies, whereas the use of these techniques in the pediatric population is less clear. The purpose of this study is to review the types of repairs and outcomes in the pediatric trauma subset of vascular surgery patients.Methods: A retrospective review of a prospectively maintained single center vascular surgery database was queried from 1/1/2014 to 12/31/2023 for procedures performed on trauma patients under the age of 16 years. Indications, demographics, operative details, and outcomes were tabulated and evaluated in standard fashion.Results: 43 patients with a mean age of 10 years (range 2 months- 16 years) underwent vascular surgery procedures for traumatic injuries. 35 (81.4%) were male and none had any of the adult type atherosclerotic risk factors. Mechanism of trauma was 23 (53.5%) blunt, 14 (32.6%) were penetrating, and 6 (13.9%) were iatrogenic. Specifically, the main causes were related to humerus fracture (13, 30.3%), knee dislocation (6, 13.9%), intra operative iatrogenic (5, 11.6%), hand through window (4, 9.3%), gunshot wound (3, 6.9%), and motor vehicle accident (3, 6.9%). Interventions involved direct repair (18, 41.7%), bypass (15, 34.9%), and fasciotomy (4, 9.3%), hematoma evacuation ( 2, 4.7%), exploration (2, 4.7 %)and thrombectomy ( 2, 4.7%). There were no endovascular interventions in this cohort. Complication rates were low with 2 (4.7%) with bypass occlusions and no limb loss. There were no peri-operative deaths. Post operatively 22 (51.2%) never followed up, 7 (16.3%) only followed up for 3 months, 13 (30.2%) followed up for 6 months and only 2 (4.6%) followed up for more than 24 months.Conclusions: Traumatic vascular injuries in pediatric civilian population are rare and extremely variable. Vascular interventions can be technically difficult secondary to vessel size and a high degree of arterial spasm. Surgical outcomes are generally good, however post-operative care protocols and length of follow-up are unclear and provide opportunity for improvement.
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