Iatrogenic Pediatric Vascular Lesions Workup

Updated: May 13, 2022
  • Author: Iman Bayat, MBBS, MRCS(Eng), FRACS(Vasc); Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Imaging Studies

The diagnosis of iatrogenic vascular trauma must be made promptly so that appropriate treatment can be initiated. Most often, the diagnosis of vascular injury is made clinically through recognition of hard signs of vascular injury (eg, bleeding or expanding hematoma). In the absence of these signs, however, imaging studies are useful for making the diagnosis.

After a change in postprocedural neurovascular observations, arterial duplex ultrasonography (US) should be performed. [4]  At present, routine postprocedural US has not been shown to be beneficial. [4]  Duplex US is sensitive in diagnosing vascular occlusions, arteriovenous fistulas (AVFs), and pseudoaneurysms. [4]  It is the preferred imaging modality in the pediatric population, in that it is noninvasive and does not involve exposure to ionizing radiation.

In the diagnosis of AVFs, computed tomography (CT) angiography (CTA) or magnetic resonance angiography (MRA) may be used to achieve better definition of the anatomy. [4]  Although CTA provides excellent imaging resolution, its risks and benefits must be carefully considered, given the known risk of radiation exposure in children.

Digital subtraction arteriography (DSA) and high-resolution US are newer techniques that may further facilitate the diagnosis and management of these injuries.