Citation

Vuoncino M, Soo Hoo AJ, Patel JA, White PW, Rasmussen TE, White JM. Ann. Vasc. Surg. 2019; ePub(ePub): ePub.

Affiliation

Division of Vascular Surgery, The Department of Surgery at the Uniformed Services University of the Health Sciences & the Walter Reed National Military Medical Center, Bethesda, Maryland. Electronic address: joseph.m.white70.mil@mail.mil.

Copyright

(Copyright © 2019, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1016/j.avsg.2019.04.014

PMID

31344461

Abstract

OBJECTIVES: The incidence of wartime upper extremity vascular injury (UEVI) has been stable for the past century. The objective of this study is to provide a contemporary review of wartime UEVI, including epidemiologic characterization and description of early limb loss.

METHODS: The Department of Defense Trauma Registry (DoDTR) was queried to identify U.S. service members who sustained a battle-related UEVI in Afghanistan between January 2009 and December 2015. Anatomic distribution of injury, mechanism of injury (MOI), associated injuries, early management, and early limb loss were analyzed.

RESULTS: Analysis identified 247 casualties who sustained 308 UEVI. The most common injury was to the vessels distal to the brachial bifurcation (63.3%, n=195), followed by the brachial vessels (27.3%, n=84) and the axillary vessels (9.4%, n=29). The predominant MOIs were penetrating explosive fragments (74.1%, n=183) and gunshot wounds (25.9%, n=64). Associated fractures were identified in 151 (61.1%) casualties, and nerve injuries in 133 (53.8%). Angiography was performed in 91 (36.8%) casualties, and endovascular treatment was performed 10 (4%) times. Temporary vascular shunts were placed in 39 (15.8%) casualties. Data on surgical management was available for 171 injuries, and included repair (48%, n=82) and ligation (52%, n=89). The early limb loss rate was 12.1% (n=30). For all casualties sustaining early limb loss, the MOI was penetrating fragments from an explosion, the average injury severity score (ISS) was 32.3 and the mortality was 6.7% (n=2). In those without amputation, the ISS and mortality were lower at 20 and 4.6% (n=10), respectively. Overall mortality was 4.9% (n=12).

CONCLUSIONS: The early limb loss rate was increased compared to initial descriptions from Operation Iraqi Freedom. Amputations are associated with a higher ISS. Improved data capture and fidelity, or differing MOIs, may account for this trend. Proficiency with open and endovascular therapy remains a critical focus for combat casualty care.

Published by Elsevier Inc.

Language: en