A decade of managing pediatric major traumatic vascular injuries: insights from a referral center.

PURPOSE

Incidence, management, and outcomes of pediatric vascular injuries secondary to non-iatrogenic trauma were reviewed over a decade in our institution.

METHODS

A retrospective review of medical records (2013-2022) of major traumatic vascular injuries, focusing on injury profiles, treatment modalities, and clinical outcomes.

RESULTS

Thirty patients with 48 vessel injuries were included. Firearms were the leading mechanism, accounting for 43.3% (n = 13) of cases. We identified 29 arterial injuries and 19 venous injuries, with 30 (62.5%) of the overall injuries occurred in the lower extremities. Shock (17; 56.7%) and associated injuries (25; 83.3%) were common. Surgery was the most common management strategy. Autologous bypass graft was the most frequently performed procedure for arterial injuries (8; 42.1%), while ligation dominated in venous injuries (9; 64.3%). Blood transfusion requirements (24; 82.7%) and post-operative prescription of anticoagulant and antiplatelet agents (12; 41.4%) were similar for arterial and venous injuries (p > 0.05). Three patients demised, resulting in a 90% survival rate. Neither the mechanism of injury, anatomical location, and presence of shock on arrival nor the baseline hemoglobin level served as predictors of mortality.

CONCLUSION

Intensive resuscitation with blood transfusion and prompt surgical intervention achieve favorable survival rates for pediatric traumatic vascular injuries. Optimal post-operative anticoagulant and antiplatelet regimens remain unclear.