Task Force to address question: How will we care for pediatric vascular patients?

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Dawn Coleman

Along with the American Pediatric Surgical Association (APSA), the Society for Vascular Surgery (SVS) plans to minimize and close some very real gaps in vascular care—treating pediatric patients.

The two organizations have formed a joint task force on the issue to identify key areas of concentration for collaborative education, guideline development, and potentially training across the vascular and pediatric surgery fields. The end goal of the SVS/APSA Task Force on Pediatric Vascular Surgery Care is advancing the understanding and care of vascular disease among pediatric patients.

“Our residents spend no defined time across programs managing kids,” said Dawn Coleman, MD, task force lead. “There are no training requirements to cover care of pediatric patients. So who will provide care, especially in acute emergencies?”

Coleman’s practice focuses in part on pediatric patients, and she covered the topic in a well-attended postgraduate course at the 2021 Vascular Annual Meeting (VAM). Resultant discussions, plus earlier conversations on the work of the SVS Population Health Task Force, “have identified a very clear gap in the care of children.” John White, MD, who is helping lead the task force effort, has long acknowledged this care gap and has sought to address it. The impetus: a young patient who could not receive the proper care in a major metropolitan area because he, the doctor, was out of town and no other vascular surgeon felt comfortable providing care to this 2-year-old.

Other cases also “really got me thinking” about the knowledge and care gaps, said White. “The fundamental issue is we don’t know how to optimize treatment for vascular problems in pediatric patients and on what basis. Right now, we have more questions than answers.”

Surgeons treating adult patients need not concern themselves with neurological, bone or muscle development, for example, said White. In addition, general physicians are getting farther afield from physical exams, utilizing imaging studies heavily instead. And, distance-walking tests—a mainstay vascular exam for adult patients—don’t provide much information in children’s cases, he pointed out.

Many vascular surgeons acknowledge significant reticence about treating pediatric patients, primarily because of lack of training, particularly in open procedures, said Coleman.

However, in the cases of critical, time-sensitive vascular emergencies, typically trauma cases, she said, “vascular surgeons may not find themselves with the precise team they’d like. This discomfort and lack of knowledge can impact the outcomes in a big way, including life or limb.”

The two doctors suggest the task force can collate clinical and practice resources for surgeons on the front lines presented with emergencies, plus working together through scientific studies to understand the natural history of the problem and care. “Ultimately, the goal from an educational perspective is to share broadly the expertise and resources of both groups,” said White, so that when faced with a pediatric vascular challenge, surgeons are empowered with appropriate resources to optimize care for these unique patients.

“We really need to work very hard and play catch-up ball, with better understanding of what children’s needs are. We need to put together education models, we need to develop brand new areas of guidance and technology, such as for operating on a premature infant.”

Coleman emphasized the importance of leveraging multidisciplinary teams for these children, especially when specialty resources may be limited by hospital constraints. In her own practice, she treats and operates on children with renovascular hypertension, a mainly developmental rare disease. “Our program rests on the expertise of the surgical team alongside pediatric nephrology, interventional radiology, cardiology, neurology, anesthesiology/ critical care and others,” she said.

White hopes the task force will go beyond putting together teams for emergencies. “Let’s get beyond that. Let’s discuss vascular care for kids overall.”

He cited care for young athletes and patient follow-up as two specific needs. “The high school athlete of today is a college athlete of 20 years ago,” he said. “The injuries we see—the vascular needs of these patients—are different now. We have to catch up.”

He regards establishing follow-up with pediatricians and pediatric situations another important priority. Emergency room surgeons rarely do follow-up care, he said. “But in the cases of pediatric vascular emergencies, we want the surgeon to become part of that child’s healthcare team.”

He treats children with congenital vascular anomalies. “Eventually that child will need to transition to both an adult primary care physician and a vascular surgeon who understand the impact of pediatric vascular issues on adult health.”

“We have the chance to do something incredible with this partnership,” said Coleman of the task force. “It will further our understanding of pediatric vascular diseases. Through data reconciliation, education and enhancing collaboration, this task force has the potential to have a powerful impact on not just rare, esoteric pediatric vascular disease, but common and time-sensitive pathology.”

The group will begin meeting in January 2022.

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