Long-term outcome in pediatric surgical bypass grafting after traumatic injury and tumor resection: retrospective cohort analysis

Abstract

Vascular bypass surgery in children differs significantly from adults. It is a rarely performed procedure in the setting of trauma and tumor surgery. Besides technical challenges to reconstruct the small and spastic vessels, another concern in bypass grafting is the adequate limb length growth over time. The primary aim of this study was to assess long-term outcome after pediatric bypass grafting, in a single academic center, focusing on potential effects on limb development. In this retrospective cohort analyses we included all pediatric patients undergoing vascular bypass grafting at our department between 2002 and 2017. All patients ≤ 18 years suffered a traumatic injury or underwent a tumor resection of the lower or upper limb. The youngest female patient was 0.4 years, the youngest male patient was 3.5 years. During the observation period, 33 pediatric patients underwent vascular repair, whereby 15 patients underwent bypass grafting. Median overall follow-up was 4.7 years (IQR ± 9). 8 patients (53%) had a traumatic injury (traumatic surgery group) and 7 patients had a planned orthopedic tumor resection (orthopedic surgery group). In 13/15 (87%) a great saphenous vein (GSV) graft and in 2/15 (13%) a Gore-Tex graft was used for bypassing. Both Gore-Tex grafts showed complete occlusion 12 and 16 years after implantation. No patient died in the early postoperative phase (< 30 days), however 3/7 (43%) in the orthopedic group died during follow-up. Revision surgery had to be performed in 1/15 (7%) patients. A functional use of the extremity was reported in all patients. Normal limb length growth according to the contralateral site, and therefore bypass growth, could be documented in 14/15 patients. Children are surgically challenging. In our study, surgery by a specialized vascular surgery team using GSV grafts led to adequate limb length and bypass growth, and we observed no functional restrictions.

A Brachial Artery Pseudoaneurysm Treated with a Bifurcated Y-Shaped Artificial Vessel Graft

“…When comparing synthetic vessel graft with autologous grafts, synthetic grafts have lower long-term patency and higher infection risk. 12,13 In our second operation, there was about a 10-cm Y-shaped defect. Because of the large defect required for reconstruction and initial failure of autologous vein graft, an artificial GORE-TEX vessel graft was chosen for reconstruction.…”

Autologous and synthetic pediatric iliofemoral reconstruction: A novel technique for pediatric iliofemoral artery reconstruction

“… 1 , 8 Previous reports in the literature have indicated success in pediatric arterial revascularization using both autologous and synthetic bypass conduits. 3 , 9 , 10 , 11 , 12 , 13 Dilation, occlusion, and stenosis are known complications associated with great saphenous vein graft use, and occlusion is associated with synthetic PTFE graft use. 9 , 12 , 13 …”

Femur Fracture With Arterial Injury in an 11-Year-Old Boy: A Case Report of a Rare Association

“…Trauma in patients aged less than 16 years with vascular injuries is uncommon and seen in only 0.6% to 1.4% [ 4 , 5 ]. Compared to adults, this incidence was reported to be significantly lower and vessels of the upper extremity are the most involved in children [ 4 ].…”