International Perspective on Extremity Vascular Trauma in Children: A Scoping Review

N Moody; A Walter; Davina Daudu; Carl-Magnus Wahlgren; Vincent Jongkind

doi:10.1016/j.ejvs.2024.02.040

International Perspective on Extremity Vascular Trauma in Children: A Scoping Review

Eur J Vasc Endovasc Surg. 2024 Feb 28:S1078-5884(24)00200-4. doi: 10.1016/j.ejvs.2024.02.040. Online ahead of print.

Authors

N Moody¹, A Walter², Davina Daudu³, Carl-Magnus Wahlgren⁴, Vincent Jongkind⁵

Affiliations

¹ Queen Elizabeth University Hospital, Glasgow, UK. Electronic address: nickmoody18@gmail.com.
² Queen Elizabeth University Hospital, Glasgow, UK.
³ Department of Surgery, University of Western Australia, Perth, Australia.
⁴ Department of Vascular Surgery, Karolinska University Hospital/Karolinska Institute, Stockholm, Sweden.
⁵ Department of Surgery, Amsterdam UMC location Vrije Universiteit, Amsterdam, the Netherlands; Microcirculation - Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.

PMID: 38428670
DOI: 10.1016/j.ejvs.2024.02.040

Abstract

Objective: Extremity vascular trauma in children can result in significant morbidity and mortality. Most published studies have focused on supracondylar humeral fracture related injuries, with little focus on other injuries. This scoping review describes the current state of knowledge on paediatric vascular injuries in the upper and lower limbs, excluding injuries related to supracondylar humeral fractures.

Methods: MEDLINE, PubMed, Web of Science, and Cochrane databases were searched for relevant studies evaluating the epidemiology, diagnosis, management, and outcomes of upper and lower limb vascular trauma in those aged under 18 years. Studies related to supracondylar humeral fractures were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews was used.

Results: A total of 39 studies was included, all of which were retrospective, and 74% of which were based in North America or Europe. Extremity vascular trauma was reported to cause 0.6 - 4.4% of all paediatric trauma admissions, with penetrating mechanisms and upper limb injuries being the most common. Operative intervention was reported in 80 - 100% of children in the included studies. Primary repair was the most commonly reported operative intervention, followed by interposition graft and bypass graft. Synthetic graft use was less commonly reported (incidence range 0.5 - 33%). Lower limb fasciotomies and amputations were not commonly reported (incidence range 0 - 23% and 0 - 13%, respectively). The mortality rate appeared low, with 23 studies reporting no deaths (incidence range 0 - 4%). Complications were reported inconsistently, with no uniform outcome or follow up measures used.

Conclusion: The incidence of extremity vascular trauma appears low in children, with penetrating mechanisms and upper extremity injuries appearing to dominate. Most studies are from high income countries, with probable selection bias towards those treated by operative intervention. Prospective studies are required focusing on patterns of injury, rates of operative and endovascular intervention, and long term outcomes.

Keywords: Extremity; Limb; Paediatric; Trauma; Vascular.

Publication types

Review