Long-term outcomes after pediatric peripheral revascularization secondary to trauma at an urban level I center

S. Keisin Wang, Natalie A. Drucker, Jodi L. Raymond, Thomas M. Rouse, Andres Fajardo, Gary Lemmon, Michael Dalsing, Brian W. Gray

Research output: Contribution to journalArticle

Abstract

Objective: The purpose of this investigation was to determine our limb-related contemporary pediatric revascularization perioperative and follow-up outcomes after major blunt and penetrating trauma. Methods: A retrospective review was performed of a prospectively maintained pediatric trauma database spanning January 2010 to December 2017 to capture all level I trauma activations that resulted in a peripheral arterial revascularization procedure. All preoperative, intraoperative, and postoperative continuous variables are reported as a mean ± standard deviation; categorical variables are reported as a percentage of the population of interest. Results: During the study period, 1399 level I trauma activations occurred at a large-volume, urban children's hospital. The vascular surgery service was consulted in 2.6% (n = 36) of these cases for suspected vascular injury based on imaging or physical examination. Our study population included only patients who received an arterial revascularization, which was performed in 23 of the 36 consultations (1.6% of total traumas; median age, 11 years). These injuries were localized to the upper extremity in 60.9% (n = 14), lower extremity in 30.4% (n = 7), and neck in 8.7% (n = 2). The mean Injury Severity Score in the revascularized cohort was 14.0 (±7.6). Bone fractures were associated with 39.1% of the vascular injuries (90% of blunt injuries). Restoration of in-line flow was achieved by an endovascular solution in one patient and open surgery in the remainder, consisting of arterial bypass in 59.1% and direct repair in 40.9%. Within 30 days of the operation, we observed no deaths, no infections of the arterial reconstruction, and no major amputations. One patient required perioperative reintervention by the vascular team secondary to the development of a superficial seroma without evidence of graft involvement. Mean follow-up in our cohort was 43.3 (±35.4) months. During this phase, no additional deaths, amputations, chronic wounds, or limb length discrepancies were observed. All vascular repairs were patent, and all but one patient reported normal function of the affected limb at the latest clinic visit. Conclusions: Traumatic peripheral vascular injury is rare in the pediatric population but is often observed secondary to a penetrating force or after long bone fracture. However, contemporary perioperative and long-term outcomes after surgical revascularization are excellent as demonstrated in this institutional case series.

Original languageEnglish (US)
JournalJournal of Vascular Surgery
DOIs
StateAccepted/In press - Jan 1 2018

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Pediatrics
Wounds and Injuries
Vascular System Injuries
Blood Vessels
Extremities
Bone Fractures
Amputation
Population
Seroma
Nonpenetrating Wounds
Injury Severity Score
Urban Hospitals
Ambulatory Care
Compassion Fatigue
Upper Extremity
Physical Examination
Lower Extremity
Neck
Referral and Consultation
Databases

Keywords

  • Limb-related outcomes
  • Pediatric
  • Revascularization
  • Trauma
  • Vascular injury

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Long-term outcomes after pediatric peripheral revascularization secondary to trauma at an urban level I center. / Wang, S. Keisin; Drucker, Natalie A.; Raymond, Jodi L.; Rouse, Thomas M.; Fajardo, Andres; Lemmon, Gary; Dalsing, Michael; Gray, Brian W.

In: Journal of Vascular Surgery, 01.01.2018.

Research output: Contribution to journalArticle

Wang, S. Keisin ; Drucker, Natalie A. ; Raymond, Jodi L. ; Rouse, Thomas M. ; Fajardo, Andres ; Lemmon, Gary ; Dalsing, Michael ; Gray, Brian W. / Long-term outcomes after pediatric peripheral revascularization secondary to trauma at an urban level I center. In: Journal of Vascular Surgery. 2018.
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AU - Wang, S. Keisin

AU - Drucker, Natalie A.

AU - Raymond, Jodi L.

AU - Rouse, Thomas M.

AU - Fajardo, Andres

AU - Lemmon, Gary

AU - Dalsing, Michael

AU - Gray, Brian W.

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N2 - Objective: The purpose of this investigation was to determine our limb-related contemporary pediatric revascularization perioperative and follow-up outcomes after major blunt and penetrating trauma. Methods: A retrospective review was performed of a prospectively maintained pediatric trauma database spanning January 2010 to December 2017 to capture all level I trauma activations that resulted in a peripheral arterial revascularization procedure. All preoperative, intraoperative, and postoperative continuous variables are reported as a mean ± standard deviation; categorical variables are reported as a percentage of the population of interest. Results: During the study period, 1399 level I trauma activations occurred at a large-volume, urban children's hospital. The vascular surgery service was consulted in 2.6% (n = 36) of these cases for suspected vascular injury based on imaging or physical examination. Our study population included only patients who received an arterial revascularization, which was performed in 23 of the 36 consultations (1.6% of total traumas; median age, 11 years). These injuries were localized to the upper extremity in 60.9% (n = 14), lower extremity in 30.4% (n = 7), and neck in 8.7% (n = 2). The mean Injury Severity Score in the revascularized cohort was 14.0 (±7.6). Bone fractures were associated with 39.1% of the vascular injuries (90% of blunt injuries). Restoration of in-line flow was achieved by an endovascular solution in one patient and open surgery in the remainder, consisting of arterial bypass in 59.1% and direct repair in 40.9%. Within 30 days of the operation, we observed no deaths, no infections of the arterial reconstruction, and no major amputations. One patient required perioperative reintervention by the vascular team secondary to the development of a superficial seroma without evidence of graft involvement. Mean follow-up in our cohort was 43.3 (±35.4) months. During this phase, no additional deaths, amputations, chronic wounds, or limb length discrepancies were observed. All vascular repairs were patent, and all but one patient reported normal function of the affected limb at the latest clinic visit. Conclusions: Traumatic peripheral vascular injury is rare in the pediatric population but is often observed secondary to a penetrating force or after long bone fracture. However, contemporary perioperative and long-term outcomes after surgical revascularization are excellent as demonstrated in this institutional case series.

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KW - Pediatric

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