Pediatric vascular injuries management: A single-center 10-years experience

Objectives: To analyze pediatric vascular injury patterns, the interventions performed, and subsequent outcomes at a Patients and Methods: This study is a retrospective review of pediatric patients, who were admitted to the University Emergency Hospital between 2010 and 2020 with an International Classification ninth of Diseases -Revision code for a traumatic vascular injury (900.0-904.9). Results: During the study period, 217 patients (mean age 12 +/- 6, 135 (62%) males) sustained vascular injuries. Upper extremity represented the most common site with 125/217 (58%) vascular injuries. Of these, 122 were arterial injury and three were venous injury. Primary arterial repair of 83/125 (66%) was the most common type of treatment in this group. No amputation was done in this group during follow-up. Lower extremity was the next most common site with 59 (27%) vascular injuries. Of these, 26 were arterial and 22 were venous injury. Iatrogenic injuries of lower extremity accounted for 16 (7%) patients. Primary arterial repair was the most common treatment with 10/59 (17%) patients. Primary belowknee amputation was done in two (1%) patients. One limb amputation was done in one threatened ischemic limb after wrong catheter insertion. Twenty-nine (13%) patients sustained head and neck vascular injuries. There were four arterial injuries and 23 venous injuries. Primary arterial repair was done in four (2%) patients. Venous ligation was done in 23 (11%) patients. One aortic injury and three inferior vena cava injuries during neuroblastoma excision was treated by primary surgical repair without complications. The mean follow-up was 31 +/- 11 months. Conclusion: Pediatric vascular injuries occur most often in the extremities. Mechanism of injury has a role in type of arterial repair. Multidisciplinary team of vascular orthopedic and plastic surgeons with individualized decisions according to presentation is the key to optimum outcome.