Open surgical repair of children less than 13 years old with lower extremity vascular injury.
OBJECTIVE
We sought to review the diagnosis and treatment of children with lower extremity vascular injury.


METHODS
We performed a query of our vascular surgery database from 1996 through 2002 to determine those with lower extremity vascular injuries requiring surgery who were also less than 13 years of age. Patient demographics, presentation, cause, surgical specifics, and outcome were sought.


RESULTS
Six children (2 girls and 4 boys) with an average age of 6.8 years (range, 2-9 years) were found. The causes were 3 blunt injuries, 2 iatrogenic injuries, and 1 penetrating injury. Associated injuries were common. There were 3 femoral and 3 popliteal artery injuries. Two were pseudoaneurysms (common femoral and popliteal artery), and 4 were acute occlusions, of which 3 experienced a delay in diagnosis. There was one primary below-knee amputation. Four reverse vein bypasses were performed, and one vein patch repair of a pseudoaneurysm was performed. Generally, 7 to 9 O interrupted Prolene (Ethicon, Inc, Somerville, NJ) repairs were performed. A delay in diagnosis (2 blunt injuries) resulted in 2 major amputations and 1 insensate foot. Four reconstructions are functioning with viable limbs (follow-up, 5-49 months). An associated brain injury resulted in the only death.


CONCLUSIONS
Vascular blunt injury is especially insidious in children. However, an aggressive approach of vascular repair, even extensive bypasses with reverse vein, will allow limb salvage in the absence of a diagnostic delay.
Dalsing
Michael C
MC
Indiana University School of Medicine, Department of Surgery, Section of Vascular Surgery, Indianapolis, USA. mdalsing@iupui.edu
Cikrit
Dolores F
DF
Sawchuk
Alan P
AP
D002648:Child; D002675:Child, Preschool; D005260:Female; D005263:Femoral Artery / Q000293:injuries*; D006801:Humans; D007511:Ischemia / Q000601:surgery; D007866:Leg / Q000098:blood supply; D023821:Limb Salvage; D008297:Male; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000293:injuries*; D011859:Radiography; D012189:Retrospective Studies; D014654:Vascular Patency; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*