Management of lower extremity vascular injuries in pediatric trauma patients: 20-year experience at a level 1 trauma center
Introduction Pediatric lower extremity vascular injuries (LEVI) are rare but can result in significant morbidity. We aimed to describe our experience with these injuries, including associated injury patterns, diagnostic and therapeutic challenges, and outcomes.Methods This was a retrospective review...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2024-02-01
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| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/9/1/e001263.full |
| _version_ | 1797321199951282176 |
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| author | Jonathan P Meizoso Arthur Berg Nicholas Namias Nicole B Lyons Brianna L Collie Juan E Sola Chad M Thorson Kenneth G Proctor Louis R Pizano Antonio C Marttos Jason D Sciarretta |
| author_facet | Jonathan P Meizoso Arthur Berg Nicholas Namias Nicole B Lyons Brianna L Collie Juan E Sola Chad M Thorson Kenneth G Proctor Louis R Pizano Antonio C Marttos Jason D Sciarretta |
| author_sort | Jonathan P Meizoso |
| collection | DOAJ |
| description | Introduction Pediatric lower extremity vascular injuries (LEVI) are rare but can result in significant morbidity. We aimed to describe our experience with these injuries, including associated injury patterns, diagnostic and therapeutic challenges, and outcomes.Methods This was a retrospective review at a single level 1 trauma center from January 2000 to December 2019. Patients less than 18 years of age with LEVI were included. Demographics, injury patterns, clinical status at presentation, and intensive care unit (ICU) and hospital length of stay (LOS) were collected. Surgical data were extracted from patient charts.Results 4,929 pediatric trauma patients presented during the 20-year period, of which 53 patients (1.1%) sustained LEVI. The mean age of patients was 15 years (range 1–17 years), the majority were Black (68%), male (96%), and most injuries were from a gunshot wound (62%). The median Glasgow Coma Scale score was 15, and the median Injury Severity Score was 12. The most commonly injured arteries were the superficial femoral artery (28%) and popliteal artery (28%). Hard signs of vascular injury were observed in 72% of patients and 87% required operative exploration. There were 36 arterial injuries, 36% of which were repaired with a reverse saphenous vein graft and 36% were repaired with polytetrafluoroethylene graft. One patient required amputation. Median ICU LOS was three days and median hospital LOS was 15 days. There were four mortalities.Conclusion Pediatric LEVIs are rare and can result in significant morbidity. Surgical principles for pediatric vascular injuries are similar to those applied to adults, and this subset of patients can be safely managed in a tertiary specialized center.Level of evidence Level IV, retrospective study. |
| first_indexed | 2024-03-08T04:55:06Z |
| format | Article |
| id | doaj.art-f6a66ce6720245f19f76142e386f6781 |
| institution | Directory Open Access Journal |
| issn | 2397-5776 |
| language | English |
| last_indexed | 2024-03-08T04:55:06Z |
| publishDate | 2024-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Trauma Surgery & Acute Care Open |
| spelling | doaj.art-f6a66ce6720245f19f76142e386f67812024-02-07T17:25:08ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762024-02-019110.1136/tsaco-2023-001263Management of lower extremity vascular injuries in pediatric trauma patients: 20-year experience at a level 1 trauma centerJonathan P Meizoso0Arthur Berg1Nicholas Namias2Nicole B Lyons3Brianna L Collie4Juan E Sola5Chad M Thorson6Kenneth G Proctor7Louis R Pizano8Antonio C Marttos9Jason D Sciarretta10Division of Trauma, Burns, and Surgical Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USAHackensack University Medical Center, Hackensack, New Jersey, USADeWitt Daughtry Family Department of Surgery, Ryder Trauma Center, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida, USADivision of Trauma, Burns, and Surgical Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USADivision of Trauma, Burns, and Surgical Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USADivision of Pediatric Surgery, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USADivision of Pediatric Surgery, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USADivision of Trauma, Burns, and Surgical Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USADivision of Trauma, Burns, and Surgical Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USADivision of Trauma, Burns, and Surgical Critical Care, Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USATrauma/Surgical Critical Care at Grady Memorial Hospital, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USAIntroduction Pediatric lower extremity vascular injuries (LEVI) are rare but can result in significant morbidity. We aimed to describe our experience with these injuries, including associated injury patterns, diagnostic and therapeutic challenges, and outcomes.Methods This was a retrospective review at a single level 1 trauma center from January 2000 to December 2019. Patients less than 18 years of age with LEVI were included. Demographics, injury patterns, clinical status at presentation, and intensive care unit (ICU) and hospital length of stay (LOS) were collected. Surgical data were extracted from patient charts.Results 4,929 pediatric trauma patients presented during the 20-year period, of which 53 patients (1.1%) sustained LEVI. The mean age of patients was 15 years (range 1–17 years), the majority were Black (68%), male (96%), and most injuries were from a gunshot wound (62%). The median Glasgow Coma Scale score was 15, and the median Injury Severity Score was 12. The most commonly injured arteries were the superficial femoral artery (28%) and popliteal artery (28%). Hard signs of vascular injury were observed in 72% of patients and 87% required operative exploration. There were 36 arterial injuries, 36% of which were repaired with a reverse saphenous vein graft and 36% were repaired with polytetrafluoroethylene graft. One patient required amputation. Median ICU LOS was three days and median hospital LOS was 15 days. There were four mortalities.Conclusion Pediatric LEVIs are rare and can result in significant morbidity. Surgical principles for pediatric vascular injuries are similar to those applied to adults, and this subset of patients can be safely managed in a tertiary specialized center.Level of evidence Level IV, retrospective study.https://tsaco.bmj.com/content/9/1/e001263.full |
| spellingShingle | Jonathan P Meizoso Arthur Berg Nicholas Namias Nicole B Lyons Brianna L Collie Juan E Sola Chad M Thorson Kenneth G Proctor Louis R Pizano Antonio C Marttos Jason D Sciarretta Management of lower extremity vascular injuries in pediatric trauma patients: 20-year experience at a level 1 trauma center Trauma Surgery & Acute Care Open |
| title | Management of lower extremity vascular injuries in pediatric trauma patients: 20-year experience at a level 1 trauma center |
| title_full | Management of lower extremity vascular injuries in pediatric trauma patients: 20-year experience at a level 1 trauma center |
| title_fullStr | Management of lower extremity vascular injuries in pediatric trauma patients: 20-year experience at a level 1 trauma center |
| title_full_unstemmed | Management of lower extremity vascular injuries in pediatric trauma patients: 20-year experience at a level 1 trauma center |
| title_short | Management of lower extremity vascular injuries in pediatric trauma patients: 20-year experience at a level 1 trauma center |
| title_sort | management of lower extremity vascular injuries in pediatric trauma patients 20 year experience at a level 1 trauma center |
| url | https://tsaco.bmj.com/content/9/1/e001263.full |
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