Special Problems of Vascular Injuries in Children

Ij, Shaker; Jj, White; Rd, Signer; Es, Golladay; Ja, Haller

doi:10.1097/00005373-197611000-00003

Cited by 57 publications

(12 citation statements)

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“…In contrast, the management of vascular injuries in adults has been well established based on extensive civilian and military experience. As reported previously, there has been an increase in vascular injuries in children and adolescents related to noniatrogenic causes [7,10]. …”

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confidence: 79%

“…Data for truncal vascular injuries in adults have changed little in the last 10 years, with a mortality of approximately 50% for all abdominal vascular injuries [11-13]. Reported pediatric vascular injuries often include iatrogenic injuries from cardiac catheterization or from percutaneous vascular access procedures (primarily catheterization of the femoral artery) [3,6,7,10]. Most of both iatrogenic and noniatrogenic vascular injuries that occur in children are extremity injuries [2].…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of truncal vascular injuries in children

Allison

Anderson

Shah

et al. 2009

Journal of Pediatric Surgery

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Background Pediatric truncal vascular injuries occur infrequently and have a reported mortality rate of 30% to 50%. This report examines the demographics, mechanisms of injury, associated trauma, and outcome of patients presenting for the past 10 years at a single institution with truncal vascular injuries. Methods A retrospective review (1997-2006) of a pediatric trauma registry at a single institution was undertaken. Results Seventy-five truncal vascular injuries occurred in 57 patients (age, 12 ± 3 years); the injury mechanisms were penetrating in 37%. Concomitant injuries occurred with 76%, 62%, and 43% of abdominal, thoracic, and neck vascular injuries, respectively. Nonvascular complications occurred more frequently in patients with abdominal vascular injuries who were hemodynamically unstable on presentation. All patients with thoracic vascular injuries presenting with hemodynamic instability died. In patients with neck vascular injuries, 1 of 2 patients who were hemodynamically unstable died, compared to 1 of 12 patients who died in those who presented hemodynamically stable. Overall survival was 75%. Conclusions Survival and complications of pediatric truncal vascular injury are related to hemodynamic status at the time of presentation. Associated injuries are higher with trauma involving the abdomen.

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confidence: 79%

Section: Discussionmentioning

confidence: 99%

Outcomes of truncal vascular injuries in children

Allison

Anderson

Shah

et al. 2009

Journal of Pediatric Surgery

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“…Shaw et al11) expressed that this may potentially increase the time required before a vascular exploration. Angiography is also invasive and has risks of iatrogenic injury to the artery due to its small size 20). In addition, there are also risks of contrast allergy.…”

Section: Discussionmentioning

confidence: 99%

Pulse Oximetry for the Diagnosis and Prediction for Surgical Exploration in the Pulseless Perfused Hand as a Result of Supracondylar Fractures of the Distal Humerus

2013

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BackgroundThe management of the pulseless perfused hand in association with a supracondylar humerus fracture following operative stabilisation remains controversial. Previous authors have suggested the use of color-flow duplex monitoring, magnetic resonance angiography and segmental pressure monitoring as objective steps to ascertain blood flow following adequate internal fixation. We examine the use of the waveform of the pulse oximeter in objectively determining a perfused limb and in predicting the need for surgical exploration in patients who present with a pulseless perfused hand after operative stabilisation for supracondylar fracture of the humerus.MethodsA retrospective review of all supracondylar fractures over a 60 month duration (2005-2009) in our instituition was performed. Each electronic record was reviewed and limbs which had absent radial pulse following admission were identified. X-ray films of each of the patients were reviewed. A search using the Pubmed database was performed with the following keywords, supracondylar humerus fracture, pediatric, pulseless, vascular injury, arterial repair.ResultsIn this series of pulseless perfused hands following operative fixation of supracondylar fracture, a total of 26 patients were reviewed. All were Gartland grade III extension type fractures. Postoperative pulse oximeter waveforms were present in all but 4 patients. These patients subsequently had exploration of the brachial artery with significant findings. In the remaining 22 patients, waveforms were present and the child had return of the radial pulse soon after operative fixation without any further need for surgical exploration. At 24 months follow-up, all children were well with no neurovascular compromise.ConclusionsThe presence of a waveform on a pulse oximeter is a sensitive and easily available modality in determining vascular perfusion as compared to other more complex investigations. The high sensitivity of this test will allow surgeons to objectively determine the requirement for surgical exploration of the brachial artery.

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“…Fortunately, major injuries to the peripheral vascular system are also rare in infants. When present, they usually have an iatrogenic origin and a catastrophic result, owing to the acute mechanism of occlusion [6,10,12]. Another rare cause of vascular injury can be observed after malignant tumor resections.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Common Femoral Artery Ligation after Sarcoma Resection in an Infant

Aponte-Tinao

Farfalli

Ayerza

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Vascular reconstruction in infants constitutes a surgical challenge and is indicated frequently for acute occlusions. With the presence of a subacute vascular occlusion, including that produced by tumor resection, collateral circulation develops quickly. Thus a surgeon can consider tumor and vessel resection, without the need for vascular reconstruction. Case Description We report the 2-year postoperative outcome of a 2-month-old boy who had a groin synovial cell sarcoma with vascular involvement, treated using limb salvage surgery with resection of the femoral vessels and without performing vascular reconstruction. Literature Review In adults with military wounds, ligation of the superficial femoral artery and common femoral artery reportedly result in amputation rates of 54% and 86%, respectively. Infants with a common femoral artery ligation may have a lower amputation rate because of some congenital collateral vessels, such as the sciatic artery. Further, when tumors involve major peripheral vessels, subacute or chronic vascular compression likely would facilitate development of collateral circulation. Similar chronic situations have been described in adults treated with debridement and common femoral artery ligation, after infected femoral artery pseudoaneurysms. Purposes and Clinical Relevance Considering our patient's history and clinical and radiographic findings, infants with musculoskeletal sarcomas involving vascular structures can be treated selectively with tumor and vessel resection without the need for vascular reconstruction if distal limb perfusion is detected intraoperatively.

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Special Problems of Vascular Injuries in Children

Cited by 57 publications

References 0 publications

Outcomes of truncal vascular injuries in children

Outcomes of truncal vascular injuries in children

Pulse Oximetry for the Diagnosis and Prediction for Surgical Exploration in the Pulseless Perfused Hand as a Result of Supracondylar Fractures of the Distal Humerus

Case Report: Common Femoral Artery Ligation after Sarcoma Resection in an Infant

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