Management of Pediatric Vascular Injury

Vascular injuries in children are relatively rare but potentially devastating. Most reported pediatric vascular injuries are iatrogenic, although larger series of non-iatrogenic and combat-related pediatric vascular trauma have appeared in the recent literature. The small caliber and hyperreactive nature of pediatric vessels makes the diagnosis and management of vascular injuries extremely challenging. Differentiating a true injury from vasospasm at the bedside often proves difficult, and the diagnostic studies in this population carry risks of radiation exposure, contrast-induced nephropathy and extravasation, and in the case of arteriography, even vascular injury. On the other hand, a delayed or missed diagnosis can result in vascular thrombosis leading to limb length discrepancies or even amputation. Recent advances in imaging technology, operative techniques, and therapeutic tools including endovascular stent grafts have expanded the management options for vascular injuries in young patients. In this chapter, we review both traumatic and iatrogenic vascular injuries in children and describe the nonoperative management along with the current trend towards surgical exploration with either ligation of nonessential vessels or reconstruction of vascular injuries using open or endovascular approaches. The need for ongoing research in this area is also discussed to encourage future multiinstitutional collaborations aimed at defining the true scope of this problem, current outcomes, and the optimal approach to these challenging injuries.