WTP1.7 Long-term Outcomes After Repair of Paediatric Traumatic Lower Limb Arterial Injury: Systematic Review

Abstract

Abstract Aims Paediatric vascular injuries account for 1% of paediatric major trauma cases with 30% of arterial injuries located in the lower limb. Current management of paediatric lower limb arterial injuries have been extrapolated from adult injuries. The aim was to review studies specific to paediatric population due to the anatomical and physiological differences, particularly limb length discrepancy (LLD) following injury. Methods A literature review was conducted. Study PICOS - Population: Patients <18 years old with traumatic lower limb arterial injury. Intervention: Surgical, endovascular or no intervention. Comparison: Primary repair or Conduit repair using autologous vein or synthetic material or endovascular repair. Outcomes: Rate of success of revascularisation, amputation, graft infection, long term limb function, LLD, mortality. Results 7 studies were included for data extraction, resulting in 15 male patients, aged 4-14. The popliteal artery was most commonly injured (60%), followed by the femoral (40%). The most common repair was with reversed Great Saphenous Vein graft (GSV)(13/15) for which good long-term outcomes were reported (85% success rate). One endovascular repair was identified which was successful and one with synthetic material which resulted in a minor complication. Conclusions There is a preference for the use of autologous vein grafts in paediatric lower limb arterial repair with good outcomes. Endovascular procedures are becoming more common whereas synthetic grafts are not favoured due to their inability to lengthen as vessels grow. Further research is required to evaluate the long-term outcomes as the current reported cases are scarce.