Management and outcome of 597 wartime penetrating lower extremity arterial injuries from an international military cohort

Sharrock, Anna E.; Tai, Nigel; Perkins, Zane; White, Joseph; Remick, Kyle N.; Rickard, Rory F.; Rasmussen, Todd E.

doi:10.1016/j.jvs.2018.11.024

Cited by 37 publications

(21 citation statements)

References 21 publications

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“…Ischemia lasting more than eight hours can cause limb loss or death. 2 The way of repair varies according to the type and location of the trauma. Accompanying additional injuries, the presence or absence of collateral circulation in the extremities, and material stock are other determining factors.…”

Section: Introductionmentioning

confidence: 99%

Current results of arterial injuries seen at femoral and popliteal arteries in civil society

2020

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Background: Lower extremity arterial injuries caused by penetrating or fired-gun trauma may result in limb or loss of life. Early intervention has critical importance. The aim of this study was to investigate the importance of early intervention and outcomes.Methods: We retrospectively reviewed the data on 144 patients (18 females, 126 males) who were treated in Istanbul Medipol University Hospital between January 2016 to 2018. All patients had an arterial injury at level of femoral and popliteal arteries. Standard statistical methods were used for data analysis.Results: Revascularization was performed to all 144 (18 females, 126 males) patients. Autologous saphenous vein graft interposition was performed in 96 patients. End-to-end repair was performed in 39 patients. 9 patients underwent a polytetrafluoroethylene graft (8 mm ringed) interposition.Conclusions: All viable limbs should be revascularized rapidly. The primary goal is to provide bleeding control rapidly and to prevent the prolongation of ischemic time. It should be kept in mind that in addition to surgical technique, fasciotomy may be required in arterial injuries with ischemic time of more than 6-8 hours.

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Section: Introductionmentioning

confidence: 99%

Current results of arterial injuries seen at femoral and popliteal arteries in civil society

2020

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“…This number increased to 2 to 3% during the Korean and Vietnam wars before increasing to 12% during the conflicts in Afghanistan and Iraq; this increase is secondary to the use of explosive mechanisms that preferentially affect the lower extremities rather than gunshot mechanism alone. 2,3 The principle surgical strategy during World War I and II was the use of tourniquets and ligation of the bleeding injured artery, which led to an overall amputation rate of 49%. This rate decreased to 13% during the Vietnam War due to the use of arterial reconstruction and rapid transport.…”

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confidence: 99%

“…5 In an international military cohort study on 597 patients who received lower wartime extremity penetrating trauma, the overall limb salvage rate was 74%. 2 The cause of increase in amputation rate compared with Vietnam was attributed to the increased injury due to explosive devices compared with gunshot wounds. Those who were injured with a gunshot mechanism had a 5-year limb salvage rate of 90% with a mortality rate of 1%, drastically improved from the early to mid-1900s.…”

mentioning

confidence: 99%

“…Those who were injured with a gunshot mechanism had a 5-year limb salvage rate of 90% with a mortality rate of 1%, drastically improved from the early to mid-1900s. 2 In the civilian setting, upper and lower PET accounts for an estimated 5 to 15% of trauma with vascular injury in roughly 1% of all extremity trauma; however, these injuries are accountable for a significant percentage of traumarelated deaths. 6,7 Femoral and popliteal artery injuries are the most common (50-60%), followed by injury to the brachial artery (30%).…”

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confidence: 99%

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Penetrating Extremity Trauma Endovascular versus Open Repair?

Kuwahara

Valeshabad

Ray

2020

Semin intervent Radiol

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Penetrating extremity trauma (PET) accounts for an estimated 5–15% of trauma with vascular injury and these injuries are accountable for a significant percentage of trauma-related deaths. Historically, vascular injuries were best treated by open repair. While a defined selection criteria and a comprehensive algorithm have not been validated, the advancement of endovascular techniques, embolotherapy, and stent grafting have become viable options for the treatment of penetrating arterial extremity trauma in select patients. Advantages endovascular repair offers include decreasing mortality and morbidity associated with open repair, decreasing blood loss, decreasing iatrogenic injury such as nerve injury, and lower rate of wound infection. Patients stability, type of vascular injury, and lesion location are main factors help deciding between endovascular and open repair. Patient selection between endovascular and open repair should be determined by on a case-by-case situation, individual hospital guidelines, a multidisciplinary approach, and technical expertise.

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“…Vascular damage control crystallized and results of intheater vascular injury management were appreciated in ways never before possible. 4,5 Most of these advances have filtered their way into modern US trauma care, affecting it in a rapid and structural way. Thankfully, with the large-scale operations drawn down, the capability of the aforementioned military research machinery to assess ongoing casualties has now faded, for us to reflect on what was accomplished.…”

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confidence: 99%

Reflect. Remember.

Clouse

2020

Annals of Vascular Surgery

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Management and outcome of 597 wartime penetrating lower extremity arterial injuries from an international military cohort

Cited by 37 publications

References 21 publications

Current results of arterial injuries seen at femoral and popliteal arteries in civil society

Current results of arterial injuries seen at femoral and popliteal arteries in civil society

Penetrating Extremity Trauma Endovascular versus Open Repair?

Reflect. Remember.

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