Vascular injury is unusual in pediatric trauma patients.
Penetrating mechanisms result in a disproportionate number of pediatric vascular injuries.
Management of these injuries often involves a multi-disciplinary team including specialists from general pediatric surgery, vascular surgery, neurosurgery, plastic and microvascular surgery, cardiothoracic surgery, neurosurgery, and interventional radiology.
Vasospasm resulting in transient vascular insufficiency is more common in children than in adults.
Blunt cerebral vascular injury may result in serious sequelae including stroke and death.
Outcome after peripheral vascular injury in children is generally associated with a viable and functional limb, except in cases of the “mangled extremity” such as those seen as a result of lawnmower injuries.
An abnormal vascular exam mandates further investigation.
In the case of penetrating trauma, an abnormal exam is all that is necessary for surgical exploration.
For peripheral vascular injuries, arteriography provides diagnostic information and in some cases may be therapeutic.
CT angiography is extremely useful for the evaluation of cerebral vascular injuries.
In the patient with normal hemodynamics, multi-detector helical CT scanning of the chest and/or abdomen can identify significant vascular abnormalities.