Giannakopoulos Nikolaos, Pitoulias Georgios, Tzamtzidou Sofia, Bontinis Vangelis, Manou Dimitra, Pitoulias Apostolos, Papas Theofanis
Vascular Surgery, Korgialeneio-Benakeio Hellenic Red Cross Hospital, Athens, GRC.
Vascular Surgery, Second Department of Surgery, G. Gennimatas Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC.
Cureus. 2024 Oct 19;16(10):e71823. doi: 10.7759/cureus.71823. eCollection 2024 Oct.
Background Pediatric vascular trauma, although rare, poses significant clinical challenges due to the potential for long-term morbidity, including limb compromise and growth abnormalities. This study addresses the gap in standardized treatment protocols by evaluating the efficacy of heparin-based conservative treatments compared to surgical interventions in children under 13 years of age. Methods A retrospective observational study was conducted at a referral center, reviewing institutional records from January 2010 to December 2020. The study included 27 pediatric patients aged up to 13 years who sustained arterial trauma involving the brachial and femoral arteries. Injuries were categorized as penetrating, blunt, or iatrogenic. Patients were divided into two age groups: those below six years and those six years and above. Treatment modalities were categorized into open surgical repair and medical management with unfractionated heparin. The diagnosis was confirmed through physical examination, Doppler ultrasound, and angiography. Results Out of 27 patients, 17 underwent surgical intervention, while 10 received medical management with heparin. An overall limb salvage rate of 87% was achieved. One case of limb loss occurred in a patient under six years who underwent surgical intervention. No significant limb-length discrepancies were observed. Surgical approaches, particularly interposition vein grafting, effectively restored palpable distal pulses. The results highlight the importance of an age-specific approach, demonstrating the effectiveness of both surgical and conservative treatments. Conclusion The study underscores the necessity for age-specific treatment protocols in pediatric vascular trauma. Individualized care resulted in high rates of limb salvage and favorable outcomes. These findings contribute to enhancing the understanding and management of pediatric vascular trauma, promoting the development of nuanced, age-tailored treatment protocols in clinical practice.
背景 小儿血管创伤虽罕见，但因其可能导致长期发病率，包括肢体功能受损和生长异常，带来了重大临床挑战。本研究通过评估基于肝素的保守治疗与手术干预对13岁以下儿童的疗效，填补了标准化治疗方案的空白。方法 在一家转诊中心进行了一项回顾性观察研究，回顾了2010年1月至2020年12月的机构记录。该研究纳入了27名年龄在13岁以下、发生涉及肱动脉和股动脉的动脉创伤的儿科患者。损伤分为穿透性、钝性或医源性。患者分为两个年龄组：6岁以下和6岁及以上。治疗方式分为开放手术修复和普通肝素药物治疗。通过体格检查、多普勒超声和血管造影确诊。结果 27例患者中，17例接受了手术干预，10例接受了肝素药物治疗。总体肢体挽救率达到87%。1例6岁以下接受手术干预的患者发生了肢体缺失。未观察到明显的肢体长度差异。手术方法，特别是静脉移植术，有效地恢复了可触及的远端脉搏。结果强调了针对特定年龄方法的重要性，证明了手术和保守治疗的有效性。结论 该研究强调了小儿血管创伤中针对特定年龄治疗方案的必要性。个体化护理导致了高肢体挽救率和良好结果。这些发现有助于增强对小儿血管创伤的理解和管理，促进临床实践中制定细致入微、针对年龄的治疗方案。
