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Trauma is the leading cause of injury and death in children older than 1 year of age, contributing to 26.7% to 36.3% of the overall mortality.1 However, vascular trauma represents only 0.65% to 1% of recorded traumatic injury.2,3 Further, when compared to vascular injuries within the adult population, the pediatric population has better outcomes with less injury severity and higher survival.3 This improvement in pediatric outcomes has been attributed to many factors including the physiologic reserve of children, the absence of vascular disease, and the higher incidence of isolated upper extremity injuries.

While most pediatric trauma patients have better outcomes than adults with comparable injury severity, vascular injuries still present an increased risk for morbidity and mortality compared to nontraumatic ones. When considering penetrating vascular injuries that are firearm-related, in-hospital mortality rates were approximately 20%, which increased to 49% when the injury was intrathoracic.3 In recent years, there has been a significant decrease in the severity of injury and resultant in-hospital mortality, particularly in those injuries caused by motor vehicle collisions, which is the second most common cause of mortality.4 This improvement has been attributed to national and state efforts to improve seat belt use and improve vehicle safety. Public health policy is paramount in decreasing the incidence of pediatric traumatic mortality; however, there is much work to be done to continue improving outcomes.4

Surgeons, particularly trauma, pediatric, and vascular specialists, need to be aware of the breadth and severity of vascular injuries in the pediatric trauma patient and how to successfully manage them. The overarching management strategy for the pediatric trauma patient is based on that of the adult trauma patient with a few important extra considerations. These considerations include the technical difficulty associated with a smaller patient size affecting incisions and exposures, the subsequent smaller size of the vessels and their continued growth after injury, the spasticity of the vessels that can mimic or hide more severe complications, and the continued axial growth of these vessels, particularly in the extremities. This chapter will focus on describing the injury patterns and physiologic characteristics unique to the pediatric population. Further it will delve into the diagnosis, management strategies, and surveillance for vascular injuries while highlighting the changes in practice with advances in technology, particularly regarding endovascular therapies and the increase in published data.


The pediatric population is typically defined as children 18 years of age or younger who comprise approximately 22% of the U.S. population based on 2019 U.S. census data.5 The leading cause of death for this population older than 1 year of age is trauma-related injuries, while it is the fifth leading cause of mortality in infants (those less than 1 year of age).1 The rates of vascular injury in these trauma patients are <1.0%.2,3 However, these injuries are not distributed evenly throughout the population. ...

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