A surgical approach to iatrogenic vascular injuries in pediatric cases

BACKGROUND: Surgical intervention is mandatory in many children who present with vascular trauma or in complicated cases after medical interventions. In this study, surgical interventions applied after vascular injuries in children were analyzed.
METHODS: Between January 2002 and December 2012, 17 patients (aged under 18) who were admitted to the emergency room with vascular injuries were retrospectively analyzed. The data was collected through hospital records. Preoperative and postoperative data of the patients were recorded and analyzed.
RESULTS: Of the total, 11 patients were female (64.7%) and 6 patients were male (35.3%) with a range of 4–192 months. In total, 14 (82.3%) injuries were due to angiographic interventions, 1 (5.9%) was due to external trauma, 1 (5.9%) was due to preoperative trauma, and 1 (5.9%) was due to a catheterization complication in the intensive care unit. Additionally, 11 (64.7%) injuries were located in the right femoral artery, 3 (17.6%) were located in the left femoral artery, 2 (11.8%) were located in the left brachial artery, and 1 (5.9%) was located in the left external iliac vein. Also, 5 (29.4%) patients were managed under local anesthesia and 12 (70.6%) patients were managed under general anesthesia. With respect to treatment, 15 (88.2%) injuries were repaired with primary sutures, 1 (5.9%) injury was repaired with an end-to-end anastomosis, and 1 (5.9%) injury was repaired with a saphenous vein graft interposition. In addition, 16 (94.1%) patients underwent a thrombectomy prior to the repair. The total hospital stay was calculated as 2.7±1.4 days. The intensive care unit stay was calculated as 1.1±0.4 days. There was no mortality, a loss of an injured extremity, or an infection. No other complication was detected.
CONCLUSION: Iatrogenic interventional procedures seem to be responsible for the majority of pediatric vascular injuries. The results of surgical repairs in these injuries are successful and efficient.

Ýyatrojenik pediatrik damar yaralanmalarýna cerrahi yaklaþým

AMAÇ: Çocuklarda travma ya da giriþimsel iþlemlere baðlý olarak meydana gelen vasküler yaralanmalarýn birçoðu cerrahi müdahale gerektirir. Bu çalýþmada herhangi bir nedenle vasküler yaralanmaya maruz kalýnan çocuklarda uygulanan cerrahi iþlemler incelendi.
GEREÇ VE YÖNTEM: Ocak 2002–Aralýk 2012 yýllarý arasýnda vasküler yaralanma nedeniyle acil operasyona alýnan 18 yaþ altý 17 hasta geriye dönük olarak incelendi. Çalýþma verilerine hastane kayýtlarýndan ulaþýldý. Çalýþmaya alýnan hastalarýn ameliyat öncesi ve ameliyat sýrasýndaki verileri kaydedildi.
BULGULAR: Hastalarýn 11’i kýz (%64.7) ve yaþ ortalamasý 60.7±54.4 ay idi. Vasküler yaralanmalarýn 14’ü (%82.3) anjiyografik iþlemlere baðlý, biri (%5.9) eksternal travmaya, biri (%5.9) ameliyat sýrasýnda travmaya, biri (%5.9) ise yoðun bakým takibi sýrasýndaki invaziv arter takibine baðlý olarak meydana gelmiþtir. Bu yaralanmalarýn 11’i (%64.7) sað femoral arterde, üçü ise (%17.6) sol femoral arterde, ikisi (%11.8) sol barakiyal arterde ve biri (%5.9) sol eksternal iliak vende gerçekleþmiþtir. Anestezi yöntemi olarak beþ (%29.4) hastada lokal, 12 (%70.6) hastada ise genel anestezi kullanýldý. Yaralanmalarýn 15’i (%88.2) primer olarak tamir edilirken, birinde (%5.9) uç-uca anastomoz, birinde (%5.9) safen ven interpozisyonu gerekmiþtir. Ayrýca 16 (%94.1) olguda ilave olarak trombektomide uygulanmýþtýr. Hastanede yatýþ süresi ortalama 2.7±1.4 gün, yoðun bakým kalýþ süresi ise 1.1±0.4 gün olarak tespit edilmiþtir. Hiçbir hastada mortalite görülmemiþ olup ekstremite kaybý, yara yeri enfeksiyonu gibi herhangi bir komplikasyon da geliþmemiþtir.
TARTIÞMA: Pediatrik vasküler yaralanmalarýn etiyolojisinde sýklýkla giriþimsel iþlemlere baðlý iyatrojenik nedenler görülmektedir. Bu tip yaralanmalarda acil olarak uygulanan cerrahi iþlemlerin sonuçlarý oldukça iyidir.