Lidie Lajoie1, Stefan C. Kenel-Pierre1, Sue Hahn1, Robert Schulze2, Andrea Hendrzak1, Mark Song1
1Surgery, SUNY Downstate Medical Center, Brooklyn, NY; 2Kings County Hospital Center, Brooklyn, NY.
OBJECTIVES: Vascular injuries in the pediatric population have historically been managed with open surgical repair (OR) though the use of endovascular techniques (EV) has become more common. This study is among the first to compare the outcomes of OR and EV modalities in the management of pediatric vascular trauma.
METHODS: A retrospective review was performed of all pediatric patients (age <18 years) treated over a 9-year study period at an urban trauma center for vascular injury. Patients with iatrogenic or isolated intracranial injuries were excluded.
RESULTS: During the study period, 60 patients suffered a total of 80 traumatic vascular injuries. Though most patients were treated with OR (84%), a significant number were managed with EV (16%). Mechanism, age, injury severity score, anatomic region of injury and time to intervention were comparable between groups. Females, however, were more likely to undergo EV than males (56% vs. 17%, p=0.02). This difference could not be attributed to injury severity. EV modalities used included embolization (77%), stent (15%) or stent-graft (8%) placement. There were no stents placed in patients under 13 years old. After an average follow-up of 6 weeks, analysis revealed no statistically significant differences in amputation rate or mortality between OR and EV, but patients treated with EV were significantly more likely to require re-intervention (38% vs. 7%, p=0.01).
CONCLUSIONS: Though the mortality and limb salvage rates between operative and endovascular management of pediatric trauma were comparable, EV treated patients were more likely to require reintervention. EV was also more likely to be chosen as the initial approach in female patients. In properly selected patients, EV modalities can have similar early outcomes to OR in the management of pediatric vascular trauma. Further study is needed to determine any long-term disparity in outcomes.
AUTHOR DISCLOSURES: S. Hahn: Nothing to disclose; A. Hendrzak: Nothing to disclose; S. C. Kenel-Pierre: Nothing to disclose; L. Lajoie: Nothing to disclose; R. Schulze: Nothing to disclose; M. Song: Nothing to disclose.
Posted April 2013