title: Outcomes of arterial vascular extremity trauma in pediatric patients.
abstract: BACKGROUND
  Vascular trauma in children, although rare, carries significant risk for repair. Here we report outcomes from a single trauma center for children with extremity vascular trauma, proximal to the digits.
  
  
  METHODS
  Retrospective chart review of patients less than age 18years with an acute, non-iatrogenic traumatic arterial vascular injury of the upper and/or lower extremity between January 2008 and December 2013. Abstracted patient demographics, injury characteristics, surgical management, and disposition were summarized and compared with nonparametric methods.
  
  
  RESULTS
  23 children comprised the study cohort: median age of 8years (IQR: 4.6-12), 61% (n=14) males, 100% survival. Penetrating injuries were the predominate mechanism (n=17, 74%). The median time to presentation was 154min (IQR: 65-330). Acute operations for revascularization included a primary repair (n=15, 65%) or reversed vein graft (n=7, 30%). Fasciotomies were done for 3 (13%) patients. Three amputations were done for failed revascularization. Upper extremity vascular injury (n=15, 65%) was more common. The rate of associated extremity fracture was similar between upper (21%) and lower (33%) extremities (p=0.643). Eight (35%) patients required additional surgery most commonly for debridement, washouts and dressing changes. Three patients' hospital stays were complicated by infection. Impaired function was the most common short- and long-term complication (60%, 75%).
  
  
  CONCLUSIONS
  Pediatric vascular injuries are commonly associated with penetrating injuries and male gender and occurred more frequently in the upper extremities. Overall patency rates after repair were 87%. Fasciotomies were done in 13% of patients, and the overall surgical amputation rate was 13%. There was no mortality in this cohort; however, multiple operations are commonly required, including the return to OR for washouts, debridements and dressing changes. The most common short- and long-term complication was impaired function. Overall good results are achievable in pediatric vascular trauma treated with revascularization.
authors: Department of Pediatric Emergency Medicine, Phoenix Children's Hospital, 1919 E Thomas Ave, Phoenix, AZ, USA, 85016. Electronic address: mkirkilas@phoenixchildrens.com.
authors: Mary
authors: M
authors: Kirkilas
authors: Department of Surgery and Level I Pediatric Trauma Center, Phoenix Children's Hospital, 1919 E Thomas Ave, Phoenix, AZ, USA, 85016; Department of Child Health, University of Arizona College of Medicine - Phoenix, 550 E Van Buren St, Phoenix, AZ, USA 85004; Department of Surgery, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ, USA 85054.
authors: David M
authors: DM
authors: Notrica
authors: Department of Surgery and Level I Pediatric Trauma Center, Phoenix Children's Hospital, 1919 E Thomas Ave, Phoenix, AZ, USA, 85016.
authors: Crystal S
authors: CS
authors: Langlais
authors: Department of Pediatric Emergency Medicine, Phoenix Children's Hospital, 1919 E Thomas Ave, Phoenix, AZ, USA, 85016; Department of Child Health, University of Arizona College of Medicine - Phoenix, 550 E Van Buren St, Phoenix, AZ, USA 85004.
authors: Jared T
authors: JT
authors: Muenzer
authors: Arizona Center for Hand Surgery, 370 E Virginia Ave, Suite 100, Phoenix, AZ, USA 85004.
authors: Jozef
authors: J
authors: Zoldos
authors: Department of Surgery and Level I Pediatric Trauma Center, Phoenix Children's Hospital, 1919 E Thomas Ave, Phoenix, AZ, USA, 85016; Department of Child Health, University of Arizona College of Medicine - Phoenix, 550 E Van Buren St, Phoenix, AZ, USA 85004.
authors: Kathleen
authors: K
authors: Graziano
mesh_terms: D000293:Adolescent; D001158:Arteries / Q000000981:diagnostic imaging / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007902:Length of Stay; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014656:Vascular Surgical Procedures / Q000379:methods*; D057772:Vascular System Injuries / Q000175:diagnosis / Q000601:surgery*; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000601:surgery*
keywords: Arterial injury; Arterial trauma; Extremity; Outcomes; Pediatric trauma