Management of lower extremity vascular injuries in pediatric trauma patients: a single Level I trauma center experience.
BACKGROUND
Traumatic vascular injuries of the lower extremity in the pediatric population are rare but can result in significant morbidity. We aimed at describing our experience with such complex injuries, with associated patterns of injury, diagnostic and therapeutic challenges, and outcomes.


METHODS
From January 2006 to December 2011, 2,844 pediatric trauma patients presented at the Ryder Trauma Center, an urban Level I trauma center in Miami, Florida. Among them, 18 patients (0.6%) were evaluated for lower extremity traumatic vascular injuries. Variables collected included age, sex, mechanism of injury, and clinical status at presentation. Surgical data included vessel injury, technical aspects of repair, associated complications, and outcomes.


RESULTS
Mean (SD) age was ± 14.7 (2.6) years (range, 6-17 years), with 17 males (94.4%). Of the 18 traumatic pediatric patients, 32 vascular injuries were identified. All arterial injuries underwent definitive operative repair. Primary repair was performed in two patients (11.1%), six (33.3%) required saphenous vein interposition grafting as initial procedure, and eight (44.4%) underwent polytetrafluoroethylene grafting. Ligation was performed in major venous injuries and deep profunda branches. The overall survival in this series was 94.4%.


CONCLUSIONS
Peripheral vascular injuries of the lower extremity in the pediatric population can result in acceptable outcomes if managed early and aggressively. Surgical principles of vascular surgery are similar to those applied to an adult. We recommend that these injuries should be managed in a tertiary specialized center with a multidisciplinary team of trauma surgeons, and pediatricians, which can potentially decrease morbidity and mortality.


METHODS
Epidemiologic study, level III.
From the Grand Strand Regional Medical Center (J.D.S.), Myrtle Beach, South Carolina; St John Hospital (F.I.B.M.), Southfield, Michigan; and Ryder Trauma Center (E.L.C., C.A.O., L.R.P., N.N.), Miami, Florida.
Jason D
JD
Sciarretta
Francisco Igor B
FI
Macedo
Eunice Lee
EL
Chung
Christian A
CA
Otero
Louis R
LR
Pizano
Nicholas
N
Namias
D000293:Adolescent; D000792:Angiography; D001158:Arteries / Q000293:injuries* / Q000601:surgery; D002648:Child; D005260:Female; D005431:Florida / Q000453:epidemiology; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D007866:Leg / Q000098:blood supply*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D015599:Trauma Severity Indices; D018616:Ultrasonography, Doppler, Duplex; D014656:Vascular Surgical Procedures / Q000379:methods*; D057772:Vascular System Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D014680:Veins / Q000293:injuries* / Q000601:surgery