Characterizing Contemporary Management of Major Pediatric Vascular Trauma: A Multiyear, Dual-Center Retrospective Analysis

Abstract

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 2 Level I trauma centers.

Study design: A retrospective review of a prospectively maintained database supplemented by trauma registry data identified all patients younger than 18 years treated for noniatrogenic vascular trauma between 2019 and 2025. Demographics, injury characteristics, interventions, outcomes, and surveillance adherence were analyzed.

Results: Among 173 pediatric patients undergoing vascular reconstruction, most were male individuals (73%), Black (69%), and sustained penetrating injuries (62%). Extremity injuries comprised 44% of reconstructable cases, whereas 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 gunshot wounds, are now responsible for the most vascular injuries in children. Although open vascular reconstruction remains the mainstay in management, endovascular use 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.