Morão Sofia, Ferreira Rita S, Camacho Nelson, Vital Vanda Pratas, Pascoal João, Ferreira M Emília, Capitão L Mota, Gonçalves Frederico B
Department of Paediatric Surgery, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, Lisbon, Portugal.
Department of Angiology and Vascular Surgery, Hospital Santa Marta, Centro Hospitalar Lisboa Central, Lisbon, Portugal.
Ann Vasc Surg. 2018 May;49:229-233. doi: 10.1016/j.avsg.2017.10.036. Epub 2018 Feb 9.
Traumatic noniatrogenic vascular injuries in children are rare and rarely discussed in literature. Pediatric vascular injuries pose a set of challenges mainly because of continued growth and development in a child or adolescent. The purpose of the study is to characterize management strategies and outcomes in these cases.
This is a single-center retrospective review of patients less than age 18 years (pediatric age) with acute, noniatrogenic traumatic vascular injuries between January 2009 and December 2015. Patient's demographics, injury characteristics, surgical management, complications, and follow-up were analyzed.
From 2009 to 2015, 3277 children with traumatic injuries were treated, of which 21 (0.6%) had 23 significant vascular injuries: 17 arterial and 6 venous injuries. The majority were males (n = 16), and the median age was 14 years (range 1 to 16 years). Penetrating injuries were the predominant mechanism (n = 21), mainly by glass (n = 13). At presentation, 4 patients were hemodynamically unstable, 3 of them in hypovolemic shock. All patients were managed operatively. Operations for arterial injuries included 5 primary arterial repairs, 4 repairs using vein grafts and 8 ligations. The following adjunct procedures were necessary: one 4-compartment leg fasciotomy due to associated soft tissue trauma, 8 tendon repairs, and 11 nerve repairs. Operations for venous injuries included 4 ligations and 2 primary repairs. There were no intraoperative or postoperative deaths, major complications, or limb loss. The median length of stay in the hospital was 6 days (range: 2-23 days). The median time of follow-up was 52 months (range: 20-94 months). Ten patients did not have any sequelae, and 11 patients reported impaired mobility and/or decreased sensation, which was transitory in most cases and related to associated neurological or muscle tendon injuries. All reconstructions remained patent over the course of follow-up. No limb asymmetry was observed.
Noniatrogenic pediatric vascular trauma is uncommon. Penetrating mechanism is more common than blunt and extremities are more frequently affected. Overall complications come from associated injuries to tendons and nerves.
儿童创伤性非医源性血管损伤较为罕见，文献中对此讨论较少。儿童血管损伤带来一系列挑战，主要是因为儿童或青少年仍在持续生长发育。本研究的目的是描述这些病例的治疗策略和结果。
这是一项单中心回顾性研究，纳入了2009年1月至2015年12月期间年龄小于18岁（儿科年龄）的急性非医源性创伤性血管损伤患者。分析了患者的人口统计学资料、损伤特征、手术治疗、并发症及随访情况。
2009年至2015年期间，共治疗了3277例创伤患儿，其中21例（0.6%）发生了23处严重血管损伤：17处动脉损伤和6处静脉损伤。大多数为男性（n = 16），中位年龄为14岁（范围1至16岁）。穿透伤是主要致伤机制（n = 21），主要由玻璃所致（n = 13）。就诊时，4例患者血流动力学不稳定，其中3例处于低血容量休克状态。所有患者均接受了手术治疗。动脉损伤的手术包括5例一期动脉修复、4例使用静脉移植物修复和8例结扎。还需要进行以下辅助手术：1例因合并软组织创伤行4个间隔的小腿筋膜切开术、8例肌腱修复和11例神经修复。静脉损伤的手术包括4例结扎和2例一期修复。术中及术后均无死亡、严重并发症或肢体缺失情况。住院中位时间为6天（范围：2至23天）。中位随访时间为52个月（范围：20至94个月）。10例患者无任何后遗症，11例患者报告有活动能力受损和/或感觉减退，大多数情况下为暂时性，与合并的神经或肌腱损伤有关。所有重建血管在随访期间均保持通畅。未观察到肢体不对称情况。
非医源性儿童血管创伤并不常见。穿透伤比钝性伤更常见，且四肢更易受累。总体并发症源于合并的肌腱和神经损伤。
