Chapter 189 - Pediatric vascular trauma Flashcards
Rate of vascular injuries in pediatric patients trauma
0.6%
Unique issues with pediatric vasculature
1) small vessel
2) spasticity of vessel
3) choice for treatment must accommodate growth
Rate of iatrogenic injuries to all pediatric vascular traumas
50%
Most common body part of noniatrogenic vascular injury
Upper extremity
Mortality rate after truncal vascular inury
50%
Rate of overlap of femoral vein and artery
12-33%
Risk factors for serious adverse events in pediatric patient going to cath
1) age < 30 days
2) weight < 2.5 kg
3) larger sheath use (>6F)
Catheter size that cause arterial spasm
1) > 50% of arterial diameter
2) < 1.9 mm smaller than artery
Late complication of pediatric vascular injury
AVF
Vascular spasm being mistaken for injury in pediatrics (rate)
26%
Non-invasive vascular assessment of pediatrics
ABI not reliable until 25 month old or BSA > 0.5 m^2
injured extremity index used instead
Injured extremity index cut off
age over 2: < 0.9
Age under 2: < 0.88
Adjuncts and strategies in pediatric vascular trauma
1) temporary vascular shunts
2) heparin
3) non-operative management of arterial injuries when appropriate
4) fasciotomy early
5) interrupted (for growth) non-absorbable sutures (less thrombogenic)
Rate of access injury in ECMO in pediatric patients
20-52%
routine reconstruction should be done
Management of pulseless pink hand after injury
controversial
Exploration in stable patient and repair should be done
Most important predictor of outcome in patients after truncal injury
Hemodynamics at time of presentation
Endovascular technique in children
limited use
mainly balloon occlusion for control only
