Surgical outcomes of peripheral vascular trauma in pediatric patients at the Cardiovascular and Thoracic Center, Viet Duc University Hospital

Xuan Hiep Vu1,2, , Duy Thang Nguyen, Vu Tu Quyen Doan3, Ngoc Thang Duong1,2, Quoc Hung Doan1,4,5
1 Hanoi Medical University
2 Viet Duc University Hospital
3 Faculty of Medicine and Health Science, University of Sydney, Australia
4 Vinmec International Times City Hospital
5 Vin University

Main Article Content

Abstract

Objective: To describe the diagnostic features, surgical methods, and outcomes of peripheral vascular injury management in pediatric patients.


Methods: A retrospective cross-sectional study was conducted on all patients under 16 years of age who underwent surgery with an intraoperative diagnosis of peripheral vascular injury due to trauma (including vasospasm, vascular contusion, and thrombosis) at the Cardiovascular and Thoracic Center, Viet Duc University Hospital, from January 2021 to December 2024.


Results: Among the 35 pediatric patients, 23 (65.7%) sustained upper limb injuries, while 12 (34.3%) had lower limb injuries. The predominant mechanism of trauma was domestic accidents (primarily unassisted falls), accounting for 24 cases (68.5%), followed by traffic accidents (n = 10, 28.6%) and one case (2.9%) of occupational injury. All patients had at least one limb fracture, including 26 closed fractures (74.3%) and 9 open fractures (25.7%). A total of 30 patients (85.7%) showed no signs of acute ischemic syndrome. Regarding treatment, intraoperative pathological findings suggestive of vascular spasm were observed in 27 cases (77.1%). Among them, five patients (14.3%) received topical papaverine to induce vasodilation, while 22 (62.9%) required arterial dilatation using a Fogarty catheter. Four patients (11.4%) with arterial contusions were treated with end-to-end anastomosis, and another four (11.4%) underwent vascular reconstruction using reversed saphenous vein grafts. One patient (2.9%) developed postoperative complications, including infection and thrombosis, requiring reoperation and vascular repair using a saphenous vein homograft.


Conclusion: Vascular trauma presents significant challenges in pediatric cases. Vascular surgeons must consider the patient’s future growth potential when planning interventions. Early diagnosis and timely treatment by experienced vascular surgeons at high-volume surgical centers can help reduce mortality and limb amputation rates.

Article Details

References

1. Hưng ĐQ, Đại NV, May NT. Chấn thương vết thương động mạch ngoại vi: hình thái tổn thương và kết quả điều trị tại bệnh viện Việt Đức. Tạp Chí Phẫu Thuật Tim Mạch Và Lồng Ngực Việt Nam. 2020 Feb 11;16:8–13.
2. Barmparas G, Inaba K, Talving P, David JS, Lam L, Plurad D, et al. Pediatric vs adult vascular trauma: a National Trauma Databank review. J Pediatr Surg. 2010 Jul;45(7):1404–12.
3. Whitehouse WM. Pediatric Vascular Trauma: Manifestations, Management, and Sequelae of Extremity Arterial Injury in Patients Undergoing Surgical Treatment. Arch Surg. 1976 Nov 1;111(11):1269.
4. Mommsen P, Zeckey C, Hildebrand F, Frink M, Khaladj N, Lange N, et al. Traumatic extremity arterial injury in children: Epidemiology, diagnostics, treatment and prognostic value of Mangled Extremity Severity Score. J Orthop Surg. 2010;5(1):25.
5. Duong TN, Doan QTV, Vo LH, Doan HQ. Single-Center Experience in Treating Peripheral Vascular Injuries in Vietnamese Children. Ann Vasc Dis. 2024;17(4):378–82.
6. Shah SR, Wearden PD, Gaines BA. Pediatric Peripheral Vascular Injuries: A Review of Our Experience. J Surg Res. 2009 May;153(1):162–6.
7. Vu TN, Phung SHD, Vo LH, Nguyen UH. Diagnosis and Treatment for Pediatric Supracondylar Humerus Fractures with Brachial Artery Injuries. Children. 2021 Oct 18;8(10):933.
8. Prieto JM, Van Gent JM, Calvo RY, Checchi KD, Wessels LE, Sise MJ, et al. Pediatric extremity vascular trauma: It matters where it is treated. J Trauma Acute Care Surg. 2020 Apr;88(4):469–76.
9. Kirkilas M, Notrica DM, Langlais CS, Muenzer JT, Zoldos J, Graziano K. Outcomes of arterial vascular extremity trauma in pediatric patients. J Pediatr Surg. 2016 Nov;51(11):1885–90.
10. Chen YX, Chen LE, Seaber AV, Urbaniak JR. Comparison of continuous and interrupted suture techniques in microvascular anastomosis. J Hand Surg. 2001 May;26(3):530–9.