Operative Treatment of Truncal Vascular Injuries in Children and Adolescents By Charles S. Cox, Jr, C. Thomas Black, James H. Duke, Christine S. Cocanour, Frederick A. Moore, Kevin P. Lally, and Richard J. Andrassy Houston, Texas BeckgroundPurpose; Pediatric truncal vascular injuries are rare, but the reported mortality rate is high (35% to 55%), and similar to that in adults (50% to 65%). This report examines the demographics, mechanisms of injury, associated trauma, and results of treatment of pediatric patients with noniatro- genie truncal vascular injuries. Methods:A retrospective review (1986 to 1996) of a pediatric (517 years old) trauma registry database was undertaken. Truncai vascular injuries included thoracic, abdominal, and neck wounds. Resuk Fifty-four truncal vascular injuries (28 abdominal, 15 thoracic, and II neck injuries) occurred in 37 patients (mean age, 14 ? 3 years; range, 5 to 17 years); injury mechanism was penetrating in 65%. Concomitant injuries occurred with 100% of abdominal vascular injuries and multiple vascular injuries occurred in 47%. Except for aortic and one SMA injury requiring interposition grafts, these wounds were repaired primarily or by lateral venorrhaphy. Nonvascular complications occurred more frequently in patients with abdominal injuries who were hemodynamically unstable (systolic blood pressure [BPS] <90) on presentation (19 major complications in 11 patients versus one major compli- cation in five patients). Thoracic injuries were primarily blunt rupture or penetrating injury to the thoracic aorta (nine T HE MANAGEMENT of vascular injuries in adult patients has been well established based on exten- sive civilian and military experience. However, vascular injuries in children have been less common, with busy pediatric trauma centers seeing an average of five cases per year.lm3 These are primarily extremity injuries or are associated with invasive procedures such as cardiac catheterization or vascular access procedures4 We and others have noted an increase in noniatrogenic vascular injuries in children and adolescents and a decline in vascular injuries associated with catheterization proce- dures.5 From the Department of Surges, University of Texas-Houston Medical School, The Hermann Hospital and The Hermann Children’s Hospital, Houston, TX. Address reprint requests to Charles S. Cox, J< MD, Universzq of Texas-Houston, Medical School, Division of Pediatric Surge?, MSB 5.246, 6431 Fannin St, Houston, TX 77030. Copyright 0 1998 by KB. Saunders Company 0022-3468/98/3303-0011$03.00/0 462 patients). Thoracic aortic injuries were treated without by- pass, using interposition grafts. In patients with thoracic aortic injuries, there were no instances of paraplegia related to spinal ischemia (clamp times, 24 ? 4 min); paraplegia occurred in two patients with direct cord and aortic injuries. Concomitant injuries occurred with 83% of thoracic injuries and multiple vascular injuries occurred in 25%. All patients with thoracic vascular injuries presenting with BPS of less than 90 died (four patients), and all with BPS 90 or over survived (eight patients). There were 11 neck wounds in 9 patients requiring intervention, and 8 were penetrating. Over- all survival was 81%; survival from abdominal vascular injuries was 94%, thoracic injuries 66%, and neck injuries 78%. Conckions: Survival and subsequent complications are related primarily to hemodynamic status at the time of presentation, and not to body cavity or vessel injured. Primary anastomosis or repair is applicable to most nonaor- tic wounds. The mortality rate in pediatric abdominal vascu- lar injuries may be lower than previously reported. J Pediatr Surg 33:462-467. Copyright o 1996 by W.B. Saun- ders Company. INDEX WORDS: Vascular trauma, abdomen, thorax. Truncal vascular injuries in children are rare, and the reported mortality rate is high (30% to 50%).z.6 Truncal vascular injuries have received little attention in the pediatric trauma literature. The purpose of this report is to examine the demographics, mechanism of injury, associ- ated trauma, and outcome of pediatric patients with noniatrogenic truncal vascular injuries treated at at a single institution. MATERIALS AND METHODS The medical records of all chrldren and adolescents (age 17 years and younger), with traumatic vascular injuries treated at the Hermann HospiWHermann Children’s Hospital and University of Texas- Houston Medical School were examined. The medical records were identified using a computerized trauma registry and database. A total of 115 vascular injurtes were identified for the period from 1986 to 1996. Truncal injurtes were defined as injuries to vascular structures within the abdomen or pelvis (not including mesenteric branch vessels such as the middle colic artery, or vascular injuries associated with solid organ mjury such as splenic artery or renal branch arteries), thorax, or neck. Extremity injuries were excluded. Data were compiled regarding patient demographics. mechanism of Jwma/ ofPediatric Surgery, Vol33, No 3 (March), 1998: pp 462-467