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Operative and nonoperative management of children aged 13 years or younger with arterial trauma of the extremities.

Abstract：

BACKGROUND:Previous studies have suggested that open repair of arterial injuries in very young children often leads to less satisfactory outcomes. The aim of this study is to describe a decade's experience in the management of pediatric arterial trauma of the limbs, with an additional specific objective to evaluate the long-term outcome of arterial traumas in preschool children treated conservatively. METHODS:Hospital charts were reviewed for all children aged < or =13 years with arterial trauma of the extremities who underwent operative or nonoperative treatment. Twenty-three children were located who had arterial traumas equally divided between the upper extremity (13) and lower extremity (10). RESULTS:The method of treatment was either open surgical repair or medical treatment consisting of systematic heparin administration. In 11 of 12 school-aged children (>6 years; mean age, 10 years), open surgical repair was performed. In six of 11 preschool children (< or =6 years; mean, 3.2 years) medical treatment was offered. Open repair was deferred in all children <2.5 years. Autologous vein interposition grafting was the most common surgical procedure and was performed in 10 patients. There were no deaths, and 87% limb salvage (21/23) was achieved. Two patients, both in the surgical arm, underwent lower limb amputation. The long-term outcome of those treated conservatively was excellent in all but one child, in whom minor limb-length discrepancy was detected. CONCLUSION:Surgical repair can be performed in school-aged children as in adults. Surgical treatment of arterial injuries in neonates, infants, and those children <2.5 years old might best be deferred in ischemic but nonthreatened limbs. In a nonthreatened ischemic extremity in this age group, systemic heparinization is an alternative safe method of management. Limb loss is rare if distal Doppler signals are present; but as children grow, limb shortening is a threat. In preschool children, the risks of an open surgical repair must be weighed against any potential benefits.

journal_name

J Vasc Surg

journal_title

Journal of vascular surgery

authors

Lazarides MK,Georgiadis GS,Papas TT,Gardikis S,Maltezos C

doi

10.1016/j.jvs.2005.09.031

subject

Has Abstract

pub_date

2006-01-01 00:00:00

pages

72-6; discussion 76

issue

eissn

0741-5214

issn

1097-6809

pii

S0741-5214(05)01703-9

journal_volume

pub_type

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Operative and nonoperative management of children aged 13 years or younger with arterial trauma of the extremities.