repair (TEVAR) in the management of traumatic aortic injuries in children.
Between 1999 and 2012, at least 12 patients younger than the age of 18 years
underwent TEVAR for traumatic aortic injuries. The youngest patient that
underwent stent placement was 11 years old. Three deaths occurred in these
cases, but they were not attributed to TEVAR-related causes. Delayed
endoleak was identified in only one patient.
Although endovascular stents may be successfully placed in children,
long-term data is still lacking. Currently, there are no stents approved for the
use in pediatric traumatic aortic injury and off-label use is largely
investigational. Selected pediatric patients considered for TEVAR include
those with an absolute contraindication to anticoagulation, such as traumatic
intracranial hemorrhage, and patients with multiply injuries making open aortic
repair prohibitively risky. Further studies are required in the pediatric
population to determine the effects of endovascular stents on the growth of the
aorta, effects of the growing aorta on stent collapse and migration, and long-
term durability of the stent material. The role of endovascular stents in pediatric
thoracic trauma, though promising, has yet to be determined.
III. SPECIFIC INJURIES
A. Pulmonary Contusion
A pulmonary contusion is lung parenchymal injury that involves alveolar
destruction, alveolar hemorrhage, and interstitial edema. It is the most common