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CT Angiography in Pediatric Extremity Trauma: Preoperative Evaluation Prior to Reconstructive Surgery

Abstract

Computed tomographic angiography (CTA) is a noninvasive modality for evaluating the vascular system and planning treatment strategies. The goal of this study was to validate the clinical utility of CTA in assessment of suspected pediatric extremity traumatic vascular injury, prior to emergent and delayed reconstructive surgery. A retrospective review was performed of all operative patients under 18 years of age who underwent multidetector-row CTA for evaluation of suspected extremity vascular injury. Parameters investigated included age, type of injury, referral source, temporal relationship between the injury and the CTA, CTA findings, operations performed, intraoperative findings, and clinical outcome. Between January 2002 and September 2005, 10 pediatric patients (6 males/4 females; mean age 8 years old, range 3–17) sustained either blunt (N = 8) or penetrating (N = 2) trauma and underwent CTA of the upper (N = 5) or lower extremities (N = 5). A total of 30% (3/10) of patients were referred from the emergency department acutely, 50% (5/10) were referred from the inpatient wards subacutely, and 20% (2/10) were referred from the outpatient clinics electively. Half (N = 5) underwent CTA to evaluate need for vascular repair, whereas half (N = 5) underwent CTA to evaluate local vasculature for flap reconstruction. Overall, 40% (4/10) of CTA findings were normal, whereas 60% (6/10) revealed traumatic vascular injuries. Pertinent nonvascular findings included soft tissue defects (60%, 6/10), fractures (40%, 4/10), and contracture deformities (20%, 2/10). In all cases, procedures were completed without complications, and intraoperative findings confirmed those from CTA. At a mean follow-up of 28 months, all injuries have healed without complications. CTA is a reliable noninvasive modality to evaluate pediatric patients with suspected traumatic extremity vascular injury and to plan treatment strategies for both vascular repair and extremity reconstruction.

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References

  1. Allen ED, Byrd SE, Darling CF, et al. The clinical and radiological evaluation of primary brain neoplasms in children, part II: Radiological evaluation. J Natl Med Assoc 1993;85:546–53.

    PubMed  CAS  Google Scholar 

  2. Berdon WE. Rings, slings, and other things: vascular compression of the infant trachea updated from the midcentury to the millennium—the legacy of Robert E. Gross, MD, and Edward B. D. Neuhauser, MD. Radiology 2000;216:624–32.

    PubMed  CAS  Google Scholar 

  3. Bogdan MA, Klein MB, Rubin GD, et al. CT angiography in complex upper extremity reconstruction. J Hand Surg [Br] 2004;29:465–9.

    CAS  Google Scholar 

  4. Brietzke SE, Jones DT. Pediatric oropharyngeal trauma: what is the role of CT scan? Int J Pediatr Otorhinolaryngol 2005;69:669–79.

    PubMed  Article  Google Scholar 

  5. Brochhagen HG, Benz-Bohm G, Mennicken U, et al. Spiral CT angiography in an infant with severe hypoplasia of a long segment of the descending aorta. Pediatr Radiol 1997;27:181–3.

    PubMed  Article  CAS  Google Scholar 

  6. Cheng YF, Chen CL, Jawan B, et al. Multislice computed tomography angiography in pediatric liver transplantation. Transplantation 2003;76:353–7.

    PubMed  Article  Google Scholar 

  7. Copley LA, Dormans JP, Davidson RS. Vascular injuries and their sequelae in pediatric supracondylar humeral fractures: toward a goal of prevention. J Pediatr Orthop 1996;16:99–103.

    PubMed  CAS  Google Scholar 

  8. Denecke T, Frush DP, Li J. Eight-channel multidetector computed tomography: unique potential for pediatric chest computed tomography angiography. J Thorac Imaging 2002;17:306–9.

    PubMed  Article  Google Scholar 

  9. Fidler JL, Cheatham JP, Fletcher SE, et al. CT angiography of complications in pediatric patients treated with intravascular stents. AJR Am J Roentgenol 2000;174:355–9.

    PubMed  CAS  Google Scholar 

  10. Franken EA, Jr., Girod D, Sequeira FW, et al. Femoral artery spasm in children: catheter size is the principal cause. AJR Am J Roentgenol 1982;138:295–8.

    PubMed  Google Scholar 

  11. Goo HW, Park IS, Ko JK, et al. Computed tomography for the diagnosis of congenital heart disease in pediatric and adult patients. Int J Cardiovasc Imaging 2005;21:347–65; discussion 367.

    PubMed  Article  Google Scholar 

  12. Gosens T, Bongers KJ. Neurovascular complications and functional outcome in displaced supracondylar fractures of the humerus in children. Injury 2003;34:267–73.

    PubMed  Article  Google Scholar 

  13. Gulati MS, Paul SB, Arora NK, et al. Esophageal and gastric vasculature in children with extrahepatic portal hypertension: evaluation by intravenous CT portography. Clin Imaging 2000;24:351–6.

    PubMed  Article  CAS  Google Scholar 

  14. Hopkins KL, Patrick LE, Simoneaux SF, et al. Pediatric great vessel anomalies: initial clinical experience with spiral CT angiography. Radiology 1996;200:811–5.

    PubMed  CAS  Google Scholar 

  15. Klineberg EO, Crites BM, Flinn WR, et al. The role of arteriography in assessing popliteal artery injury in knee dislocations. J Trauma 2004;56:786–90.

    PubMed  Google Scholar 

  16. McNutt R, Seabrook GR, Schmitt DD, et al. Blunt tibial artery trauma: predicting the irretrievable extremity. J Trauma 1989;29:1624–7.

    PubMed  CAS  Article  Google Scholar 

  17. Medina LS, D’Souza B, Vasconcellos E. Adults and children with headache: evidence-based diagnostic evaluation. Neuroimaging Clin N Am 2003;13:225–35.

    PubMed  Article  Google Scholar 

  18. Napoli A, Fleischmann D, Chan FP, et al. Computed tomography angiography: state-of-the-art imaging using multidetector-row technology. J Comput Assist Tomogr 2004;28 Suppl 1:S32–45.

    PubMed  Article  Google Scholar 

  19. Norton KI. New imaging applications in the evaluation of pediatric renal disease. Curr Opin Pediatr 2003;15:186–90.

    PubMed  Article  Google Scholar 

  20. Panaro F, Testa G, Balakrishnan N, et al. Living related small bowel transplantation in children: 3-dimensional computed tomography donor evaluation. Pediatr Transplant 2004;8:65–70.

    PubMed  Article  Google Scholar 

  21. Park JH. Conventional and CT angiographic diagnosis of Takayasu arteritis. Int J Cardiol 1996;54 Suppl:S165–71.

    PubMed  Article  Google Scholar 

  22. Peng RY, Bongard FS. Pedestrian versus motor vehicle accidents: an analysis of 5,000 patients. J Am Coll Surg 1999;189:343–8.

    PubMed  Article  CAS  Google Scholar 

  23. Raaymakers TW, Rinkel GJ, Ramos LM. Initial and follow-up screening for aneurysms in families with familial subarachnoid hemorrhage. Neurology 1998;51:1125–30.

    PubMed  CAS  Google Scholar 

  24. Reid JR, Morrison SC, DiFiore JW. Thoracic outlet syndrome with subclavian aneurysm in a very young child: the complementary value of MRA and 3D-CT in diagnosis. Pediatr Radiol 2002;32:22–4.

    PubMed  Article  Google Scholar 

  25. Ross DA, Witzel MA, Armstrong DC, et al. Is pharyngoplasty a risk in velocardiofacial syndrome? An assessment of medially displaced carotid arteries. Plast Reconstr Surg 1996;98:1182–90.

    PubMed  Article  CAS  Google Scholar 

  26. Schaffler GJ, Sorantin E, Groell R, et al. Helical CT angiography with maximum intensity projection in the assessment of aortic coarctation after surgery. AJR Am J Roentgenol 2000;175:1041–5.

    PubMed  CAS  Google Scholar 

  27. Siegel MJ. Multiplanar and three-dimensional multi-detector row CT of thoracic vessels and airways in the pediatric population. Radiology 2003;229:641–50.

    PubMed  Article  Google Scholar 

  28. Vranicar M, Hirsch R, Canter CE, et al. Selective coronary angiography in pediatric patients. Pediatr Cardiol 2000;21:285–8.

    PubMed  Article  CAS  Google Scholar 

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Correspondence to James Chang.

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Hsu, C.S., Hellinger, J.C., Rubin, G.D. et al. CT Angiography in Pediatric Extremity Trauma: Preoperative Evaluation Prior to Reconstructive Surgery. HAND 3, 139–145 (2008). https://doi.org/10.1007/s11552-007-9081-z

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  • DOI: https://doi.org/10.1007/s11552-007-9081-z

Keywords

  • Computed tomographic angiography
  • Clinical utility
  • Pediatric extremity traumatic vascular injury