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Congenital disease of the vasculature 

Congenital disease of the vasculature
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date: 19 September 2019

Vascular disease in children is uncommon, and challenges the vascular surgeon due to the presenting pathology and unfamiliarity with paediatric presentation. Trauma is the most common presentation, with the pulseless hand complicating a supracondylar fracture or the ischaemic leg following iatrogenic femoral artery injury being the most frequent. Congenital vascular diseases ranging from vascular malformations to severe aortic and arterial abnormalities also present in early childhood. Awareness and recognition of these disorders is required in order to facilitate specialist paediatric vascular opinion. Acquired vascular diseases are rare in children, but require clinical awareness and prompt tertiary referral to achieve the best outcomes. A major challenge in paediatric patients is the small calibre of the vessels, particularly in pre-term neonates and infants. Thrombolysis is important in the management of acute occlusive disease. Endovascular treatments currently have a limited role, while in contrast to adult vascular disease, open surgical intervention remains the mainstay of treatment for most arterial disease in children. Finally, management by a multi-disciplinary team is of paramount importance.

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