Problems in surgical treatment of pediatric vessel injuries

master's thesis

• Title (croatian): Problemi u kirurškom liječenju ozljeda krvnih žila u djece
• Author: Lea Catharina Flockenhaus
• Mentor: Tomislav Meštrović (mentor)
• Committee member: Tomislav Meštrović (predsjednik povjerenstva)
• Committee member: Predrag Pavić (član povjerenstva)
• Committee member: Boško Skorić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2021-07-16, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Pediatric vessel injuries are rare and associated with high mortality and morbidity. This is owed to the distinct anatomical and physiological features in children, which are significantly different from those in adults. Their smaller, spastic and more fragile vessels predispose to vascular occlusion and cause a lower injury threshold. Due to the tendency of children’s vessels to go into vasospasm upon trauma, the severity of injury might get concealed and lead to non-recognition. Furthermore, despite possessing a larger neoangiogenic potential, which accounts for the good tissue viability seen in pediatric patients following reconstructions, children are more sensitive to chronic ischemia, since it can give rise to limb-length discrepancies as the child grows. There are several complications that could arise from vessel injuries in children, ranging from arteriovenous fistulas, pseudoaneurysms, vessel occlusions, to compartment syndrome and limb loss. The diagnosis and treatment of each of these complications, depend on the mechanism, location and severity of injury, as well as other factors, i.e. the age of the patient. The fast and efficient management of pediatric vessel injuries is further complicated by the lack of training and experience of surgeons regarding these specific cases. One of the main areas of interest for research in the field of pediatric vascular surgery, is the development of tissue-engineered vascular grafts that are able to grow with the child and circumvent the downsides connected to autologous and synthetic grafts.

Abstract (croatian)

Ozljede krvnih žila su rijetke u djece i imaju veliki mortalitet i morbiditet. Tome doprinose anatomska i fiziološka obilježja djece, koja su značajno različita od onih u odraslih osoba. Manje, spastične i krhke žile u djece povećavaju sklonost okluziji krvnih žila i snizuju prag tolerancije na ozljede. Zbog sklonosti dječjih krvnih žila vazospazmu nakon traume, težina krvožilne ozljede može biti prikrivena, što dovodi do izostanka njenog prepoznavanja. Nadalje, unatoč tome što djeca posjeduju veći neoangiogeni potencijal, što objašnjava dobru održivost tkiva viđenu u dječjih bolesnika nakon rekonstrukcije, ona su osjetljivija na kroničnu ishemiju, koja može dovesti do odstupanja u dužini udova tokom rasta djeteta. Postoji nekoliko komplikacija koje nastaju kao posljedica ozljeda krvnih žila u djece, od arteriovenskih fistula, pseudoaneurizama i okluzija žila, do sindroma mišićnih odjeljaka i gubitka ekstremiteta. Dijagnoza i liječenje svake od ovih komplikacija ovise o mehanizmu, mjestu i težini ozljede, kao i o ostalim čimbenicima, te o dobi pacijenta. Brzo i učinkovito zbrinjavanje ozljeda dječjih žila dodatno je otežano nedostatkom obuke i iskustva kirurga u tim specifičnim slučajevima. Jedno od glavnih područja istraživačkog interesa u području dječje vaskularne kirurgije je razvoj vaskularnih graftova dobivenih tkivnim inženjerstvom (engl. “tissue engineered vascular grafts”) koji su sposobni za rast i zaobilaze nedostatke povezane s autolognim i sintetičkim graftovima.

• Keywords: pediatric vessel injuries; iatrogenic; endovascular procedures; vascular grafts
• Keywords (croatian): ozljede krvnih žila u djece; jatrogene; endovaskularni postupci; vaskularni graftovi
• Language: english
• URN:NBN: urn:nbn:hr:105:536063
• Study programme: Title: Medicine (in English language); Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-12-21 08:45:35