Turkiye Klinikleri Cardiovascular Sciences

.: ORIGINAL RESEARCH
Çocukluk Çağı Damar Yaralanmalarında Cerrahi Tedavi Tecrübelerimiz
Our Surgical Treatment Experiences in Childhood Vascular Injuries
Metin Onur BEYAZa, Didem Melis ÖZTAŞb, Alican VURANc, Murat UĞURLUCANa
aİstanbul Medipol Üniversitesi Tıp Fakültesi, Kalp ve Damar Cerrahisi ABD, İstanbul, TÜRKİYE
bİstanbul Bağcılar Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, İstanbul, TÜRKİYE
cÜmraniye Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, İstanbul, TÜRKİYE
Turkiye Klinikleri J Cardiovasc Sci. 2020;32(2):53-8
doi: 10.5336/cardiosci.2019-72646
Article Language: TR
Full Text
ÖZET
 Amaç: Çocuklarda vasküler yaralanmalar, uzun dönemde ekstremitede gelişim bozukluğu gibi ciddi komplikasyonlara neden olabileceğinden ayrı bir öneme sahiptir. Biz bu yazıda çocukluk çağı vasküler yaralanmalarında uyguladığımız tedavi yöntemlerini ve sonuçlarını paylaşmayı amaçladık. Gereç ve Yöntemler: Çocukluk çağı vasküler yaralanma nedeni ile opere edilen 32 hasta retrospektif olarak incelendi. Hastaların 30 (%93,75)'u erkek, 2 (6,25)'si kadındı. Ortalama yaş 11.2 idi. On sekiz hastada (%56,2) kesici-delici alet yaralanması, 9 hastada (%28,1) ateşli silah yaralanması ve 5 hastada (%15,6) travmaya sekonder yaralanma mevcuttu. Revaskülarizasyon tekniği olarak üst ekstremite arteriyel yaralanması ile başvuran 3 hastada ucuca tamir tekniği, 1 hastada otolog ven ile patchplasti, 2 hastada otolog ven interpozisyonu uygulandı. Alt ekstremite yaralanmalarında ise, hastaların 18' inde uc-uca tamir, 4 hastada ven interpozisyonu, 2 hastada venöz patchplasti ve 2 hastada primer onarım uygulandı. Bulgular: Radial artere primer tamir uygulanan bir hastada 1. ayda iskemi oluşturmayan oklüzyon gelişti. Alt ekstremitede venöz patchplasti ve primer onarım yapılan birer olguda psödoanevrizma gelişti. İzole popliteal arter yaralanması olan ve uc-uca tamir uygulanan bir olguda 1. Ayda popliteal vende derin venöz tromboz saptandı ve medikal tedavi düzenlendi. Uyuşturucu madde kullanım öyküsüne sahip bir hastada yara yeri enfeksiyonu gözlendi. Sonuç: Çocukluk çağında artan arteriyel yaralanmalar ilk planda en doğru ameliyat yöntemi ve gereklilik halinde en doğru greft seçimi ile revaskülarize edilmeli, özellikle erken çocuk yaş gurubunda büyüme ve gelişmenin devam ettiği göz ardı edilmemelidir.

Anahtar Kelimeler: Çocukluk çağı; periferik arter yaralanmaları
ABSTRACT
 Objective: Vascular injuries in children carry high importance, as they can cause serious complications, such as a developmental disoders of limbs in the long term. In this article, we aimed to share the treatment methods and results we used in childhood vascular injuries. Material and Methods: 32 patients who underwent operation depending on pediatric vascular injury were examined retrospectively. 30 (%93,75) patients were male and 2 (6,25) patients were female. Mean age was 11.2.Vasculary injuries were due to penetrating trauma in 18 (%56,2) patients,firearm injury in 9 (%28,1) patients and secondary to trauma in 5 (%15,6) patients. End to end repair was performed in 3 patients,patchplasty was performed in 1 patient and vein interposition was performed in 2 patients in upper extremity. In lower extremity, 18 patients underwent end to end repair, 4 patients underwent vein interposition, 2 patients underwent patchplasty and 2 patients underwent primary repair. Results: In one patient who underwent primary repair in radial artery, non-ischemic occlusion was detected in 1 month. Pseudoaneurysm developed in one patient with patchplasty and in one patient with primary repair in the lower extremity. In one patient with isolated popliteal artery injury and end-toend repair,deep venous thrombosis was detected in popliteal vein after 1 month and medically treated. Wound infection was observed in one patient with a history of drug use. Conclusion: Increased arterial injuries in childhood should be revascularized with the most accurate surgical method and,if necessary,with the right graft selection, and it should not be overlooked that the growth and development continue especially in early childhood group.

Keywords: Childhood; peripheral arterial injuries
REFERENCES:
  1. Barmparas G, Inaba K, Talving P, David JS, Lam L, Plurad D, et al. Pediatric vs adult vascular trauma: a National Trauma Databank review. J Pediatr Surg. 2010;45(7):1404-12. [Crossref]  [PubMed] 
  2. Corneille MG, Gallup TM, Villa C, Richa JM, Wolf SE, Myers JG, et al. Pediatric vascular injuries: acute management and earlyoutcomes. J Trauma. 2011;70(4):823-8. [Crossref]  [PubMed] 
  3. Mousa A, Zakaria OM, Hanbal I, Sultan TA, El-Gibaly AM, Zakaria MY, et al. Operative management of non-iatrogenic pediatric and adolescence peripheral arterial trauma: an experience from a resource challenged setting. Asian J Surg. 2019;42(7):761-7. [Crossref]  [PubMed] 
  4. Lazarides MK, Georgiadis GS, Papas TT, Gardikis S, Maltezos C. Operative and nonoperative management of children aged 13 years or younger with arterial trauma of the extremities. J Vasc Surg. 2006;43(1):72-6; discussion 76. [Crossref]  [PubMed] 
  5. Markovic MD, Cvetkovic SD, Koncar IB, Dragas MV, Markovic DM, Kukic BP, et al. Treatment of pediatric vascular injuries: the experience of a single non-pediatric referral center. Int Angiol. 2019;38(3):250-5. [Crossref]  [PubMed] 
  6. Tünerir B, Beşoğlu Y, Yavuz T, Al-Eqaidat A, Aslan R, Kural T, et al. [Peripheral arterial injuries and results of treatment]. GKDC Derg. 1998;6:151-4. [Crossref] 
  7. Hossny A. Blunt popliteal artery injury with complete lower limb ischemia: is routine use of temporary intraluminal arterial shunt justified? J Vasc Surg. 2004;40(1):61-6. [Crossref]  [PubMed] 
  8. White L, Mehlman CT, Crawford AH. Perfused, pulseless, and puzzling: a systematic review of vascular injuries in pediatric supracondylar humerus fractures and results of a POSNA questionnaire. J Pediatr Orthop. 2010;30(4):328-35. [Crossref]  [PubMed] 
  9. Mulpuri K, Wilkins K. The treatment of displaced supracondylar humerus fractures: evidence-based guideline. J Pediatr Orthop. 2012;32(Suppl 2):S143-52. [Crossref]  [PubMed] 
  10. Solak H, Yeniterzi M, Yüksek T, Eren N, Ceran S, Göktoğan T. Injuries of the peripheral arteries and their surgical treatment. Thorac Cardiovasc Surg. 1990;38(2):96-8. [Crossref]  [PubMed] 
  11. Lee HY, Reddy SC, Rao PS. Evaluation of superficial femoral artery compromise and limb growth retardation after transfemoral artery balloon dilatations. Circulation. 1997;195(4): 974-80. [Crossref]  [PubMed] 
  12. Van Waes OJF, Van Lieshout EMM, Hogendoorn W, Halm JA, Vermeulen J. Treatment of penetrating trauma of the extremities: ten years' experience at a Dutch level 1 trauma center. Scand J Trauma Resusc Emerg Med. 2013;21:2. [Crossref]  [PubMed]  [PMC] 
  13. Ergunes K, Yilik L, Ozsoyler I, Kestelli M, Ozbek C, Gurbuz A. Traumatic brachial artery injuries. Tex Heart Inst J. 2006;33(1):31-4.
  14. Selçuk Kapısız N, Kapısız HF. [Approach to peripheral vascular injuries]. Turkiye Klinikleri J Cardiovasc Sci. 2013;25(3):133-41.
  15. Wang SK, Drucker NA, Raymond JL, Rouse TM, Fajardo A, Lemmon GW, et al. Long-term outcomes after pediatric peripheral revascularization secondary to trauma at an urban level I center. J Vasc Surg. 2019;69(3):857-62. [Crossref]  [PubMed] 
  16. Cardneau JD, Henke PK, Upchurch Jr GR, Wakefield TW, Graham LM, Jacobs LA, et al. Efficacy and durability of autogenous saphenous vein conduits for lower extremity arterial reconstructions in preadolescent children. J Vasc Surg. 2001;34(1):34-40. [Crossref]  [PubMed] 
  17. Wahlgren CM, Kragsterman B. Management and outcome of pediatric vascular injuries. J Trauma Acute Care Surg. 2015;79(4):563-7. [Crossref]  [PubMed] 
  18. Klinkner DB, Arca MJ, Lewis BD, Oldham KT, Sato TT. Pediatric vascular injuries: patterns of injury, morbidity, and mortality. J Pediatr Surg. 2007;42(1):178-82; discussion 182-3. [Crossref]  [PubMed] 

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