Twenty years of pediatric vascular surgery consultations and interventions at a tertiary academic center.

Abstract

Pediatric vascular surgery is infrequent, heterogeneous, and lacks standardized care models. We sought to characterize the full spectrum of pediatric vascular surgery consultations, interventions, multidisciplinary involvement, and long-term outcomes within an integrated academic health system over a 20-year period. We performed a retrospective cohort study of all pediatric patients (aged <18 years) evaluated by vascular surgery from 2004 to 2024 at a single tertiary academic center with an affiliated children's hospital. Demographics, consultation characteristics, operative details, and longitudinal outcomes were abstracted from the electronic health record. Interventions were categorized as arterial, aortic, or venous. Descriptive statistics were used. A total of 342 pediatric patients were evaluated by vascular surgery across inpatient and ambulatory (clinic-based) settings during the study period. The patients were 51.5% male and had a median age of 14.2 years (interquartile range, 10.2-16.4 years). Inpatient consultations accounted for 54.1%, and 60.0% were urgent or emergent. Most consultations (62.0%) did not require operative intervention. Vascular interventions were performed in 129 patients (37.7%), predominantly by vascular surgeons (91.5%). Arterial interventions (n = 81) included trauma repairs, renal artery reimplantation, decompression or entrapment syndromes, patch angioplasty, and 31 bypasses. Autogenous conduit was used in 96.8% of bypasses and demonstrated primary vein graft patency was 72.4% at a median 5-year follow-up, with no failures attributable to somatic growth. Aortic interventions (n = 10) included thoracic endovascular repair for blunt thoracic aortic injury (n = 4) and varied abdominal reconstructions (n = 5), all with durable early and midterm outcomes; one late embolic event occurred after thoracic endovascular repair. Venous interventions (n = 37) most commonly included thoracic outlet decompression (n = 12), dialysis access surgery (n = 6), and oncological vascular assistance (n = 4). Reinterventions occurred primarily in dialysis access patients. The overall median follow-up was 4.6 years. Of 85 patients who reached adulthood, 32.9% successfully transitioned to adult vascular surgery care. Pediatric vascular surgery represents a high-acuity, consult-driven practice with a broad disease spectrum and excellent operative safety when intervention is required. However, substantial gaps in longitudinal surveillance and transition to adult care persist, even within an integrated health system. Structured pediatric vascular care pathways and formal transition strategies are needed to ensure durable, lifelong outcomes.