Paediatric arterial injury: management options at the time of injury.

Arterial injury in children presents a challenge, even to the experienced vascular surgeon. In order to evaluate established management guidelines, the clinical records of all patients under 12 years of age presenting with arterial injury were studied. Over a 4-year period, a total of 40 patients were treated; 29 after blunt trauma, and 11 with penetrating injuries. Upper limb vessels were involved in 17 cases, lower limb in 20, renal in two and facial in one. In most patients with penetrating injury, haemorrhage from the wound made urgent surgery mandatory. In the 29 patients who had sustained blunt injury and were submitted to operation, no repair was necessary in 14. The clinical signs of absent pulses were due to spasm. Thirteen required reverse vein graft, and in two no repair was attempted: in one patient the renal artery was ligated, and in the other ischaemic forearm muscles precluded any recovery. In those children referred for vascular opinion, it would appear that arterial spasm is an important problem after blunt trauma. In this subgroup, operation may be averted in some patients with the use of intravenous digital subtraction angiography. Exploration is mandatory if there is any doubt about the limb viability.