Author/Editor		Flis, Vojko; Tomažič, Tomaž
Title		Zapletene poškodbe žilja spodnjih udov pri otrocih
Translated title		Complex vascular injuris of lower limbs in children
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 76, št. 7-8
Publication year		2007
Volume		str. 467-72
Language		slo
Abstract		Background Pediatric vascular trauma is rare and there is scarcity of data available to direct optimal care of these patients. Even rarer are reports of long term venous function after complex vascular repairs of lower extremities. Purpose of article is to evaluate the long term arterial and venous function after complex vascular repairs with interposition vein graft, vein by-pass graft or modified veno-venous saphenous vein by-pass graft. A prospective cohort study of children with combined lower extremity vessel injuries (arterial and venous) treated during 10-year period (1995‐2005). All patients were followed up in regular six months intervals by color flow duplex ultrasound imaging. Six months after injury radioisotopic phlebography was performed. In selected cases arteriography was performed and isotopic phlebography repeated. Patients Seventeen patients (range 3‐16 years, 15 male) were followed up (range 6 months ‐ 10 years) after complex trauma of lower extremities (traffic-related injuries 15 cases, farming machines-related injuries 2 cases). By all patients there were associated injury of bone structures and other associated injuries. There were 10 patients with extensive laceration of superficial femoral artery and vein. Both vessels were reconstructed with an interposition vein graft (great saphenous vein). There were 7 patients with extensive popliteal artery and vein laceration and associated injuries to crural vessels. Vessels were reconstructed (arterial part) with reversed vein by-passes (three cases of additional popliteo-pedal bypass) and with veno-venous saphenous vein by-passes (venous part) with H interponat. Results All repairs were patent, with no evidence of deep venous thrombosis. There were no signs of chronic venous insufficiency. By three patients with veno-venous by-pass varicose veins developed. There were no disturbances in limb growth. (Abstract truncated at 2000 characters)
Summary		Izhodišča Poškodbe žilja pri otrocih so redke. Podatki o najbolj ustreznem načinu zdravljenja takihpoškodovancev so pomanjkljivi. Še redkejša so poročila o dolgoročnih rezultatih kirurškeobnove žilja spodnjih udov pri otrocih, posebej tistih na venskem delu.Namen dela je bil oceniti dolgoročno prehodnost po kompleksni obnovi hkratnih arterijskihin venskih poškodb spodnjih udov, ki so bile kirurško obnovljene bodisi z avtovenskimvsadkom ali avtovenskim obvodom na arterijski strani in bodisi z avtovenskim vsadkom ali modificiranim safenopoplitealnim obvodom na venski strani. Bolniki in metode Šlo je za prospektivno raziskavo otrok s kompleksnimi poškodbami žilja spodnjih udov (arterij in ven) v obdobju od 1995 do 2005. V skupino je bilo vključenih 17 otrok (starost od 3‐16 let, 15 dečkov). Vsi otroci so imeli dodatno poškodovano tudi okostje spodnjih udov. 15 otrok je bilo poškodovanih v prometnih nesrečah, dva s kmetijskimi stroji. Pri 10 sta bili poškodovani a. in v. femoralis superficialis. Obe žili sta bili kirurško obnovljeni z avtovenskim vsadkom. Pri 7 je šlo za poškodbe v področju a. in v. popliteje. Arterijski del je bil kirurško obnovljen z avtovenskim obvodom. Venski del je bil obnovljen z modificiranim safenopoplitealnim obvodom. Vsi bolniki so bili v šestmesečnih presledkih po operaciji pregledani z dvojnim barvnim doplerskim ultrazvokom. Pri vseh je bila šest mesecev po operaciji opravljena radioizotopska flebografija. Kronično vensko popuščanje po operaciji smo ocenjevali s klinično lestvico po CEAP. Najkrajši čas spremljave je bil šest mesecev, najdaljši deset let. Rezultati V opazovanem obdobju ni bilo zapletov na arterijski strani. Na venski strani so vse rekonstrukcije v opazovanem obdobju prehodne. Pri treh bolnikih s safenopoplitealnim venskim obvodom so se razvile varice velike safene brez znakov kroničnega venskega popuščanja.Zastojev v rasti prizadetega uda ni bilo. (Izvleček skrajšan pri 2000 znakih)
Descriptors		FEMORAL FRACTURES FEMORAL ARTERY FEMORAL VEIN BLOOD VESSEL PROSTHESIS POPLITEAL ARTERY CHILD POPLITEAL VEIN TREATMENT OUTCOME