Background: Pediatric vascular trauma carries high morbidity, limb loss, and mortality. This study describes contemporary injury and management patterns and identifies predictors of limb loss and death among pediatric vascular trauma patients at two Level I trauma centers. Study Design: A retrospective review of a prospectively maintained database supplemented by trauma registry data identified all patients <18 years treated for non-iatrogenic vascular trauma between 2019–2025. Demographics, injury characteristics, interventions, outcomes, and surveillance adherence were analyzed. Results: Among 173 pediatric patients undergoing vascular reconstruction, most were male (73%), African American (69%), and sustained penetrating injuries (62%). Extremity injuries comprised 44% of reconstructable cases, while most head/neck injuries were managed nonoperatively. Arterial reconstruction was performed in 95 patients (23 arterial ligations, 14 primary repairs, 4 patch angioplasties, 54 extremity bypasses). Venous reconstruction occurred in 49 patients (25 venous ligations, 10 primary repairs, 1 patch angioplasty, 24 venous bypasses). 29 (17%) of patients underwent endovascular treatment, including 6 therapeutic aorto/iliac and 1 venacaval interventions. Postoperative surveillance adherence was 78% and declined with increasing age. Despite 55% of lower extremity revascularizations requiring infrageniculate targets, major amputation occurred in only 1.2% of patients. Vascular-related mortality was 6.3% and exclusive to adolescents with penetrating torso or junctional injuries presenting in shock; all-cause mortality was 11.5% and driven by traumatic brain injury. Conclusions: Penetrating injuries, particularly GSWs, are now responsible for the most vascular injuries in children. While open vascular reconstruction remains mainstay in management, endovascular utilization is increasing. Limb salvage and adherence to surveillance strategies supersede that seen for adult cohorts with similar injuries. Predictors for limb loss and vascular-related death include mangled extremity, delays in care, and shock on arrival.
Lang et al. (Tue,) studied this question.