A 10-year analysis of paediatric extremity vascular injuries in a Tertiary Referral Centre

Background And Aims: Non-iatrogenic vascular injuries affecting the extremities of children pose a challenge to paediatric surgeons due to their rarity and non-specific presentations. Our aims were to assess the injury profiles, management strategies and short-term outcomes of this condition following paediatric trauma. Methods: A retrospective analysis of the medical records of patients who presented with vascular injuries, focusing on extremity injuries, over 10 years from 2013 to 2022 in our centre in Cape Town, South Africa was conducted. Results: 21 children sustained vascular injuries involving the extremities, affecting 32 vessels (n=22, 68.8% arteries and n=10, 31.2% veins). Males predominated at 76.2% (n=16) with a median age of 11 years and three months and a weight of 30 kg. Road traffic accidents (RTA) were predominant at 47.6% (n=10), followed by firearms at 38.1% (n=8). The femoral artery and popliteal artery were the most frequently injured vessels, accounting for 28.1% (n=9) each. Lower extremity injuries predominated over upper extremity injuries for both arteries (n=20, 90.1%) and veins (n=10, 100%) from our series, and majority (n=31, 96.5%) had surgical interventions. Autologous bypass graft was the most performed procedure at 52.9% (n=9) for the arterial injuries, while for venous injuries, ligation dominated at 85.7% (n=6). Four patients (9.5%) with seven vessels injured underwent primary amputations. All these patients sustained multiple injuries following RTAs, and all four subsequently underwent interventions i.e. amputations within four hours of presentation for haemostasis. Overall, three patients (14.3%), including one who had undergone primary amputation, succumbed to their injuries, all of whom sustained injuries involving femoral arteries. Conclusion: Early major bleeding remains the primary cause of mortality for vascular injuries involving the extremities. Hence, the more proximal the vessel is, the greater the mortality risk. Early diagnosis, resuscitation and prompt intervention, including consideration of damage control measures and/or primary limb amputation when necessary are crucial for reducing mortality rates, prioritizing the principle of saving lives over limbs.