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Venous injuries in pediatric trauma: Systematic review of injuries and management

Rowland, Simon Peter MRCS (Eng); Dharmarajah, Brahman MRCS (Eng); Moore, Hayley M. MRCS (Eng); Dharmarajah, Katie MRCPCH; Davies, Alun H. FRCS

Journal of Trauma and Acute Care Surgery: August 2014 - Volume 77 - Issue 2 - p 356–363
doi: 10.1097/TA.0000000000000312
Review Articles

BACKGROUND Diagnosis of vascular injury in pediatric trauma is challenging as clinical signs may be masked by physiologic compensation. We aimed to (1) investigate the prevalence of noniatrogenic pediatric venous injuries, (2) discuss options in management of traumatic venous injury, and (3) investigate mortality from venous injury in pediatric trauma. Our objective was to provide the practicing clinician with a summary of the published literature and to develop an evidence-based guide to the diagnosis and management of traumatic venous injuries in children.

METHODS A systematic review of published literature (PubMed) describing noniatrogenic traumatic venous injury in the pediatric population (<17 years) was performed according to PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-Analyses] guidelines. Data were retrieved systematically under the following headings: Study Design, Population Demographics (dates of recruitment, mean age, mechanism of injury), Diagnostic Approach, Vessel Injured, Management (operative technique), and Mortality.

RESULTS Thirteen articles were included in this systematic review. In total, 508 noniatrogenic traumatic venous injuries were reported in children between the year 1957 and present day. Mechanisms of injury included blunt trauma from seat belt–related injury and fall from height or penetrating trauma from gunshot and foreign object. Injury to the inferior vena cava was most frequently reported, followed by femoral vein and internal jugular injuries. Primary repair was the most frequently reported technique for surgical repair (38%), followed by ligation (25%) and end-to-end anastomosis (15%). Mortality in pediatric trauma patients who had venous injury was reported as 0% to 67% in published series, highest in the series in which the most frequently reported injury was of the inferior vena cava.

CONCLUSION Traumatic venous injury in the pediatric population is uncommon but may be associated with significant morbidity and mortality. Intra-abdominal venous injuries are associated with high mortality from exsanguination. Early diagnosis and intervention are therefore essential in such cases.

LEVEL OF EVIDENCE Systematic review, level IV.

From the Academic Section of Vascular Surgery (S.P.R., B.D., H.M.M., A.H.D.), Imperial College London (S.P.R.); and Department of Paediatrics (K.D.), Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom.

Submitted: December 7, 2013, Revised: April 15, 2014, Accepted: April 18, 2014.

This study was presented at the XVII World Meeting of the International Union of Phlebology, September 8–13, 2013, Boston, Massachusetts.

Address for reprints: Alun H. Davies, FRCS, Academic Section of Vascular Surgery, Imperial College London, 4 North, Charing Cross Hospital, Fulham Palace Rd, London W6 8RF, UK; email:

© 2014 Lippincott Williams & Wilkins, Inc.