NONIATROGENIC PEDIATRIC VASCULAR TRAUMA - A 10-YEAR EXPERIENCE AT A LEVEL-I TRAUMA CENTER

We retrospectively reviewed all pediatric patients (<18 years old) who presented to a Level I trauma center from 1984 to 1994 with noniatrog enic vascular trauma. There were 48 patients (42 male and 6 female) ag es 2 to 17 years. Mechanism of injury included gunshot wounds (34) sta b wounds (10), and blunt trauma (4). The lower extremities were most c ommonly injured (31), followed by upper extremity (17), trunk (8), and neck (4). Twenty-one (44%) patients had associated nonvascular injuri es (primarily orthopedic or peripheral nerve). Eighteen (37%) patients underwent preoperative angiography for suspected extremity (15) or ca rotid injuries (3). Twenty-nine patients went to surgery without angio graphy based on severe ischemia (11) or hemorrhage (18). Arterial inju ries (45) were managed by interposition reverse saphenous vein graft ( 16), primary repair (15), ligation (5), or other operative (5) and non operative treatment (4). Venous injuries (15) were treated with primar y repair (8), patch (3), ligation (3), and nonoperative management (1) . Fasciotomy was performed in six (12%). There were three deaths (6%), all due to aortic and/or caval injuries. Limb salvage in survivors wa s 100 per cent. There were no complications from angiography. Postoper ative duplex scans demonstrated patency in six of the seven patients s tudied with venous injuries. We conclude that 1) noniatrogenic pediatr ic vascular trauma is uncommon, and 2) using an aggressive approach to both the diagnosis and treatment of these injuries can achieve excell ent limb salvage rates with a low morbidity and mortality.