CT angiography in pediatric extremity trauma: preoperative evaluation prior to reconstructive surgery.
Computed tomographic angiography (CTA) is a noninvasive modality for evaluating the vascular system and planning treatment strategies. The goal of this study was to validate the clinical utility of CTA in assessment of suspected pediatric extremity traumatic vascular injury, prior to emergent and delayed reconstructive surgery. A retrospective review was performed of all operative patients under 18 years of age who underwent multidetector-row CTA for evaluation of suspected extremity vascular injury. Parameters investigated included age, type of injury, referral source, temporal relationship between the injury and the CTA, CTA findings, operations performed, intraoperative findings, and clinical outcome. Between January 2002 and September 2005, 10 pediatric patients (6 males/4 females; mean age 8 years old, range 3-17) sustained either blunt (N = 8) or penetrating (N = 2) trauma and underwent CTA of the upper (N = 5) or lower extremities (N = 5). A total of 30% (3/10) of patients were referred from the emergency department acutely, 50% (5/10) were referred from the inpatient wards subacutely, and 20% (2/10) were referred from the outpatient clinics electively. Half (N = 5) underwent CTA to evaluate need for vascular repair, whereas half (N = 5) underwent CTA to evaluate local vasculature for flap reconstruction. Overall, 40% (4/10) of CTA findings were normal, whereas 60% (6/10) revealed traumatic vascular injuries. Pertinent nonvascular findings included soft tissue defects (60%, 6/10), fractures (40%, 4/10), and contracture deformities (20%, 2/10). In all cases, procedures were completed without complications, and intraoperative findings confirmed those from CTA. At a mean follow-up of 28 months, all injuries have healed without complications. CTA is a reliable noninvasive modality to evaluate pediatric patients with suspected traumatic extremity vascular injury and to plan treatment strategies for both vascular repair and extremity reconstruction.
Hsu
Charles S
CS
Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, 770 Welch Rd, Ste 400, Palo Alto, CA, 94305, USA.
Hellinger
Jeffrey C
JC
Rubin
Geoffrey D
GD
Chang
James
J
Radiology. 2000 Sep;216(3):624-32
10966687
Int J Cardiol. 1996 Aug;54 Suppl:S165-71
9119519
J Hand Surg Br. 2004 Oct;29(5):465-9
15336751
AJR Am J Roentgenol. 2000 Feb;174(2):355-9
10658704
J Thorac Imaging. 2002 Oct;17(4):306-9
12362069
Transplantation. 2003 Jul 27;76(2):353-7
12883192
Curr Opin Pediatr. 2003 Apr;15(2):186-90
12640276
AJR Am J Roentgenol. 1982 Feb;138(2):295-8
6976734
Int J Cardiovasc Imaging. 2005 Apr-Jun;21(2-3):347-65; discussion 367
16015453
J Trauma. 2004 Apr;56(4):786-90
15187743
J Natl Med Assoc. 1993 Jul;85(7):546-53
8350377
Pediatr Radiol. 2002 Jan;32(1):22-4
11819057
Radiology. 2003 Dec;229(3):641-50
14563904
Pediatr Cardiol. 2000 May-Jun;21(3):285-8
10818198
AJR Am J Roentgenol. 2000 Oct;175(4):1041-5
11000160
Int J Pediatr Otorhinolaryngol. 2005 May;69(5):669-79
15850688
Pediatr Radiol. 1997 Feb;27(2):181-3
9028857
Clin Imaging. 2000 Nov-Dec;24(6):351-6
11368936
J Am Coll Surg. 1999 Oct;189(4):343-8
10509458
J Pediatr Orthop. 1996 Jan-Feb;16(1):99-103
8747364
J Trauma. 1989 Dec;29(12):1624-7
2593189
Injury. 2003 May;34(4):267-73
12667778
J Comput Assist Tomogr. 2004 Jul-Aug;28 Suppl 1:S32-45
15258492
Radiology. 1996 Sep;200(3):811-5
8756937
Neuroimaging Clin N Am. 2003 May;13(2):225-35
13677803
Neurology. 1998 Oct;51(4):1125-30
9781541
Plast Reconstr Surg. 1996 Dec;98(7):1182-90
8942903
Pediatr Transplant. 2004 Feb;8(1):65-70
15009843