VESS20 - Vascular Surgery consults in the pediatric population over 20 years

Objectives: Vascular injury in pediatric patients is rare but could be complex and associated with significant mortality and morbidity. We aim to investigate types of vascular surgery consults for pediatric population and the importance of Vascular surgery team at our hospital.

Methods: A single-center retrospective chart review of vascular surgery consults for pediatric patients between 2004 - 2024. Exclusion criteria included absent formal consult, referral for vascular lab study or podiatry, non-pediatric age at the time of consult. WHO pediatric age categorization was reviewed and categorized into outpatient and inpatient consults.

Results: 342 vascular surgery consults were identified. 185/342 (54.1%) were inpatient consults with 86 (46.4%) females; with median age of 13.6 with IQR (5.97- 16.9). The consulting services included pediatrics (42/185 (22.7%), ED 40/185 (21.9%), trauma surgery 24/185 (12.9%) and pediatric surgery 21 (11.3%) most commonly. There were 16/185 (8.6%) intraoperative consults (7/16 (43.7%) males, 9/16 (56.2%) females). Consults for vascular repair occurred in 9/16 (56.2%) cases in the setting of trauma, iatrogenic injury, vascular involvement in tumors, or occlusion. There were 3/16 (18.7%) consults for bleeding, of which, one required monitoring for intraoperative hematoma. 4/16 (25%) consults were for further intra-operative investigations and diagnosis. Most common service requesting intra-operative consults was pediatric surgery 8/16 (50%).
Outpatient referrals were 157/342 (45.9%), with 80/157 (50.1%) females. The median age was 14.84 with IQR (11.9-16.54). Ten (6.3%) were urgent and 38 (24.2%) resulted in Vascular operations.
The number of operations performed was 126/342 (36.8%). Of which, 117 (92.8%) were done by vascular surgery (17 (14.5%) endo and 102 (87.1%) open), 8 (2.3%) were referred to IR, and 1 (0.29%) was operated on by hand surgery after vascular surgery referral. Vascular surgeons performed several operations for a wide range of indications. The most common was arterial repair either primarily, with patching, graft, reconstruction, or revascularization due to trauma, oncological resection, or occlusion in 55 cases (47%). Rib resection was done in 12 (10.2%). Aortic aneurysm repair and traumatic injury requiring endograft repair of the thoracic aorta was done in 6 (5.1%). Vascular surgeons were the co-surgeons on 41/117 (35%) consult cases, most commonly with orthopedics surgery.

Conclusions: Although vascular pathology is less common among the pediatric population, in cases of trauma, injury, and vascular encasement, the role of vascular surgery service is critical and the skillset that vascular surgery can offer is diverse. The vascular surgeon is essential in aiding other services in the pediatrics population.