Operative treatment of truncal vascular injuries in children and adolescents

Charles S. Cox, C. Thomas Black, James H. Duke, Christine S Cocanour, Frederick A. Moore, Kevin P. Lally, Richard J. Andrassy

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Background/Purpose: Pediatric truncal vascular injuries are rare, but the reported mortality rate is high (35% to 55%), and similar to that in adults (50% to 65%). This report examines the demographics, mechanisms of injury, associated trauma, and results of treatment of pediatric patients with noniatrogenic truncal vascular injuries. Methods: A retrospective review (1986 to 1996) of a pediatric (≤ 17 years old) trauma registry database was undertaken. Truncal vascular injuries included thoracic, abdominal, and neck wounds. Results: Fifty-four truncal vascular injuries (28 abdominal, 15 thoracic, and 11 neck injuries) occurred in 37 patients (mean age, 14 ± 3 years; range, 5 to 17 years); injury mechanism was penetrating in 65%. Concomitant injuries occurred with 100% of abdominal vascular injuries and multiple vascular injuries occurred in 47%. Except for aortic and one SMA injury requiring interposition grafts, these wounds were repaired primarily or by lateral venorrhaphy. Nonvascular complications occurred more frequently in patients with abdominal injuries who were hemodynamically unstable (systolic blood pressure [BPS] <90) on presentation (19 major complications in 11 patients versus one major complication in five patients). Thoracic injuries were primarily blunt rupture or penetrating injury to the thoracic aorta (nine patients). Thoracic aortic injuries were treated without bypass, using interposition grafts. In patients with thoracic aortic injuries, there were no instances of paraplegia related to spinal ischemia (clamp times, 24 ± 4 min); paraplegia occurred in two patients with direct cord and aortic injuries. Concomitant injuries occurred with 83% of thoracic injuries and multiple vascular injuries occurred in 25%. All patients with thoracic vascular injuries presenting with BPS of less than 90 died (four patients), and all with BPS 90 or ever survived (eight patients). There were 11 neck wounds n 9 patients requiring intervention, and 8 were penetrating. Overall survival was 81%; survival from abdominal vascular injuries was 94%, thoracic injuries 66%, and neck injuries 78%. Conclusions: Survival and subsequent complications are related primarily to hemodynamic status at the time of presentation, and not to body cavity or vessel injured. Primary anastomosis or repair is applicable to most nonaortic wounds. The mortality rate in pediatric abdominal vascular injuries may be lower than previously reported.

Original languageEnglish (US)
Pages (from-to)462-467
Number of pages6
JournalJournal of Pediatric Surgery
Volume33
Issue number3
DOIs
StatePublished - Mar 1998
Externally publishedYes

Fingerprint

Vascular System Injuries
Thoracic Injuries
Wounds and Injuries
Abdominal Injuries
Therapeutics
Pediatrics
Blood Pressure
Neck Injuries
Multiple Trauma
Paraplegia
Survival
Neck
Thorax
Transplants
Mortality
Thoracic Aorta
Registries
Rupture
Ischemia
Hemodynamics

Keywords

  • Abdomen
  • Thorax
  • Vascular trauma

ASJC Scopus subject areas

  • Surgery

Cite this

Cox, C. S., Black, C. T., Duke, J. H., Cocanour, C. S., Moore, F. A., Lally, K. P., & Andrassy, R. J. (1998). Operative treatment of truncal vascular injuries in children and adolescents. Journal of Pediatric Surgery, 33(3), 462-467. https://doi.org/10.1016/S0022-3468(98)90089-6

Operative treatment of truncal vascular injuries in children and adolescents. / Cox, Charles S.; Black, C. Thomas; Duke, James H.; Cocanour, Christine S; Moore, Frederick A.; Lally, Kevin P.; Andrassy, Richard J.

In: Journal of Pediatric Surgery, Vol. 33, No. 3, 03.1998, p. 462-467.

Research output: Contribution to journalArticle

Cox, Charles S. ; Black, C. Thomas ; Duke, James H. ; Cocanour, Christine S ; Moore, Frederick A. ; Lally, Kevin P. ; Andrassy, Richard J. / Operative treatment of truncal vascular injuries in children and adolescents. In: Journal of Pediatric Surgery. 1998 ; Vol. 33, No. 3. pp. 462-467.
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abstract = "Background/Purpose: Pediatric truncal vascular injuries are rare, but the reported mortality rate is high (35{\%} to 55{\%}), and similar to that in adults (50{\%} to 65{\%}). This report examines the demographics, mechanisms of injury, associated trauma, and results of treatment of pediatric patients with noniatrogenic truncal vascular injuries. Methods: A retrospective review (1986 to 1996) of a pediatric (≤ 17 years old) trauma registry database was undertaken. Truncal vascular injuries included thoracic, abdominal, and neck wounds. Results: Fifty-four truncal vascular injuries (28 abdominal, 15 thoracic, and 11 neck injuries) occurred in 37 patients (mean age, 14 ± 3 years; range, 5 to 17 years); injury mechanism was penetrating in 65{\%}. Concomitant injuries occurred with 100{\%} of abdominal vascular injuries and multiple vascular injuries occurred in 47{\%}. Except for aortic and one SMA injury requiring interposition grafts, these wounds were repaired primarily or by lateral venorrhaphy. Nonvascular complications occurred more frequently in patients with abdominal injuries who were hemodynamically unstable (systolic blood pressure [BPS] <90) on presentation (19 major complications in 11 patients versus one major complication in five patients). Thoracic injuries were primarily blunt rupture or penetrating injury to the thoracic aorta (nine patients). Thoracic aortic injuries were treated without bypass, using interposition grafts. In patients with thoracic aortic injuries, there were no instances of paraplegia related to spinal ischemia (clamp times, 24 ± 4 min); paraplegia occurred in two patients with direct cord and aortic injuries. Concomitant injuries occurred with 83{\%} of thoracic injuries and multiple vascular injuries occurred in 25{\%}. All patients with thoracic vascular injuries presenting with BPS of less than 90 died (four patients), and all with BPS 90 or ever survived (eight patients). There were 11 neck wounds n 9 patients requiring intervention, and 8 were penetrating. Overall survival was 81{\%}; survival from abdominal vascular injuries was 94{\%}, thoracic injuries 66{\%}, and neck injuries 78{\%}. Conclusions: Survival and subsequent complications are related primarily to hemodynamic status at the time of presentation, and not to body cavity or vessel injured. Primary anastomosis or repair is applicable to most nonaortic wounds. The mortality rate in pediatric abdominal vascular injuries may be lower than previously reported.",
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