1- Paediatric Surgery Department, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, Portugal
2- Department of Angiology and Vascular Surgery, Hospital Santa Marta, Centro Hospitalar Lisboa Central, Portugal
3- NOVA Medical School, Lisbon, Portugal
- Artigo aceite para publicação no Annals of Vascular Surgery a 24 de Outubro de 2017 e publicado online a 9 de Fevereiro de 2018
Introduction: Traumatic non-iatrogenic vascular injuries in children are rare and rarely discussed in literature. Paediatric 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.
Patients and methods: Single-centre retrospective review of patients less than age 18 years (paediatric age) with acute, non-iatrogenic traumatic vascular injuries between January 2009 and December 2015. Patient’s demographics, injury characteristics, surgical management, complications and follow-up were analyzed.
Results: 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. 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 hemodinamically 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 intra or postoperative deaths, major complications or limb loss. The median length of stay in the hospital was 6 days (range 2 to 23 days). The median time of follow-up was 52 months (range 20 to 94 months). Ten patients didn’t 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.
Conclusion: Noniatrogenic paediatric 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.
Palavras-chave: paediatric trauma, noniatrogenic vascular injury, vascular repair, outcomes