Department of Surgery, Emory University Hospital, Atlanta, GA, 30341, USA.
Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
Pediatr Surg Int. 2024 Sep 28;40(1):256. doi: 10.1007/s00383-024-05837-3.
Pediatric lower extremity vascular injury (PLEVI) is uncommon and the availability of granular data is sparse. This study evaluated the surgical management of PLEVIs between a Level I adult (ATC) vs pediatric (PTC) trauma center.
We performed a retrospective review of PLEVIs (< 18 years) managed surgically between 01/2009-12/2022. Demographics and outcome data were obtained. Primary outcomes included amputation and fasciotomy rates. Secondary outcomes included type of vessel repair, mortality, and hospital length of stay.
Seventy-nine patients were identified, 41 at the ATC and 38 at the PTC, totaling 112 vessels injured. ATC patients were older (median years 16.0 vs 12.5) and almost exclusively (97.6% vs 29.0%) gunshot wounds. Vascular surgeons managed 50% of injuries at the ATC vs 73.7% at the PTC (p = 0.10). Amputations were uncommon and not significantly different between centers. Seventeen patients (44.7%) required fasciotomies at the PTC vs 21 (51.2%) at the ATC (p = 0.56). Rates of vessel repair, ligation, grafting, mortality, and hospital length of stay were not significantly different.
PLEVI can be managed safely at ATCs and PTCs with acceptable outcomes. However, important nuances in patient triage and management need to be considered. Multi-institutional comprehensive datasets are needed.
Level III.
小儿下肢血管损伤（PLEVI）并不常见，颗粒数据的可用性也很有限。本研究评估了一级成人（ATC）和小儿（PTC）创伤中心之间 PLEVI 的手术治疗。
我们对 2009 年 1 月至 2022 年 12 月期间接受手术治疗的 PLEVI（<18 岁）进行了回顾性研究。获取了人口统计学和结果数据。主要结局包括截肢和筋膜切开术的发生率。次要结局包括血管修复的类型、死亡率和住院时间。
共确定了 79 例患者，其中 41 例在 ATC，38 例在 PTC，总共 112 个血管损伤。ATC 患者年龄较大（中位数为 16.0 岁 vs. 12.5 岁），几乎均为枪伤（97.6% vs. 29.0%）。血管外科医生在 ATC 治疗了 50%的损伤，而在 PTC 治疗了 73.7%的损伤（p=0.10）。截肢并不常见，两个中心之间没有显著差异。17 例（44.7%）患者需要在 PTC 进行筋膜切开术，而在 ATC 有 21 例（51.2%）（p=0.56）。血管修复、结扎、移植、死亡率和住院时间没有显著差异。
PLEVI 可以在 ATC 和 PTC 安全地进行治疗，结果可接受。然而，需要考虑患者分诊和管理方面的重要细微差别。需要多机构综合数据集。
III 级。
