Vascular Injuries of the Extremity

Abstract

Pediatric peripheral vascular injuries are uncommon but can cause significant morbidity and mortality. These injuries are often iatrogenic secondary to central venous catheter placement; however, traumatic fractures or direct penetrating trauma can cause vascular trauma as well. In traumatic extremity injuries, prompt examination and diagnosis are required in order to prevent limb loss and potential mortality. Soft and hard signs of vascular injuries must be evaluated to determine whether immediate surgical intervention is required. Additionally, the appropriate application of tourniquets can minimize blood loss while other life-threatening injuries are evaluated. The use of adjuncts such as ultrasound with duplex, computerized tomography (CT), and magnetic resonance angiography (MRA) can assist in the diagnosis and management of vascular injuries. Although endovascular techniques have made many advances over the last two decades, the mainstay of operative management in trauma is still open vascular exploration and repair. The availability of vascular expertise, operative resources, and hemodynamic status of the patient will determine the best operative approach. The key technical aspects of hemorrhage control, exposure, shunting, ligation, and vascular anastomosis (if possible) are imperative for optimal outcomes and decreased life-long morbidity. The variability in vessel sizes, physiologic response to shock, and propensity for vasospasm are some of the unique challenges in pediatric vascular trauma that must be considered in treating these injuries.