Outcome after vascular trauma in a deployed military trauma system

Stannard, Adam; Brown, Katherine E.; Benson, Cedric; Clasper, J; Midwinter, Mark J.; Tai, Nigel

doi:10.1002/bjs.7359

Cited by 44 publications

(15 citation statements)

References 17 publications

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“…The mortality in neither cohort includes those who died from hemorrhage or other causes before arrival at a medical treatment facility, an outcome classified as killed in action in the military system. As such, this study does not provide a complete view of the lethality of arterial injury, such as that reported by Tai et al 33 from the British military which included analysis of those killed in action. These limitations notwithstanding, both the JTTR and NTDB have been used extensively to report on vascular injury patterns, methods of management, and short-term outcomes in the past.…”

Section: Discussionmentioning

confidence: 90%

Anatomic distribution and mortality of arterial injury in the wars in Afghanistan and Iraq with comparison to a civilian benchmark

Markov

DuBose²,

Scott

et al. 2012

Journal of Vascular Surgery

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Mortality of injured service personnel who reach a medical treatment facility after major arterial injury compares favorably to a matched civilian standard. Acceptable mortality rates within the military cohort are related to key aspects of an organized Joint Trauma System, including prehospital tactical combat casualty care, rapid medical evacuation to forward surgical capability, and implementation of clinical practice guidelines. Aspects of this comprehensive combat casualty care strategy may translate and be of value to management of arterial injury in the civilian sector.

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Section: Discussionmentioning

confidence: 90%

Anatomic distribution and mortality of arterial injury in the wars in Afghanistan and Iraq with comparison to a civilian benchmark

Markov

DuBose²,

Scott

et al. 2012

Journal of Vascular Surgery

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“…The rate of vascular injury in the wars in Iraq and Afghanistan is higher than previously reported in combat, with injury to extremity vessels being most common1–3 ( Fig. ).…”

Section: Introductionmentioning

confidence: 79%

Reperfusion strategies in the management of extremity vascular injury with ischaemia

Percival

Rasmussen

2011

British Journal of Surgery

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Background: Extremity injury with ischaemia is the most common pattern of vascular trauma and is a challenge for surgeons who must make decisions about the timing and mechanism of limb reperfusion. In modern military conflicts, effective use of limb tourniquets and rapid transport of the injured have increased the number of casualties who reach a medical service with potentially survivable vascular trauma. This report provides a review of extremity ischaemia and reperfusion following vascular trauma.Methods: A review was undertaken of extremity vascular injury with ischaemia, including a focus on adjuncts aimed at reducing reperfusion injury and improving neuromuscular recovery and limb salvage.Results: Findings from basic and clinical research support the need to restore perfusion to an ischaemic limb as soon as possible in order to achieve optimal neuromuscular recovery. Large-animal studies demonstrate that haemorrhagic shock worsens the impact of ischaemia on the neuromuscular structures of the limb and reduces the ischaemic threshold to as little as 1 h. Surgical adjuncts such as vascular shunts, fasciotomy, regional limb cooling and ischaemic conditioning may reduce the severity of ischaemic injury. Medical therapies have also been described including hypertonic saline, statins and ethyl pyruvate, which reduce the inflammatory response following limb reperfusion. Conclusion:Contemporary translational research refutes a casual approach to extremity vascular injury with ischaemia, instead emphasizing expedited reperfusion. Surgical and medical adjuncts exist to expedite reperfusion and mitigate reperfusion injury. Additional research and development of these adjuncts is necessary to improve quality or functional limb salvage after vascular trauma.

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“…The conflicts in Afghanistan and Iraq have witnessed an increase in the incidence of vascular injury compared with previous combat reports 1, 2, 3, 4, 5, 6. To reduce the ischaemia time of injured limbs, temporary vascular shunts (TVS) are commonly used 7 .…”

Section: Introductionmentioning

confidence: 99%

Locked Temporary Vascular Shunt for Wartime Vascular Injuries

Wang

Gou

et al. 2016

EJVES Short Reports

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IntroductionTo reduce the ischaemia time of injured limbs in wartime, temporary vascular shunts (TVS) are commonly used. However, TVS are stabilized at the ends of the injured vessels using manual suture ties, the risk of dislodgement is high, and tightening manual suture ties is too time consuming.Technical summaryLocked temporary vascular shunts (LTVS) were designed, and each was composed of a silicone tube with a threaded outer surface and smooth inner surface in addition to two nylon buckle switches. The buckle switches were used to stabilize the silicone tube of the LTVS with respect to the vessel walls. This job was performed with two manual suture ties with the current TVS. The mean bursting pressure value of the veins shunted with the LTVS was 114.3% higher than that of the veins shunted with the TVS (0.045 ± 0.008 MPa vs. 0.021 ± 0.012 MPa; p = .00). Although the mean shunting time of the LTVS was reduced by 60.4% compared with that of the TVS (138.89 ± 18.22 seconds vs. 350.48 ± 52.20 seconds; p = .00), there was no significant difference in the patency times between the two types of devices (8.20 ± 9.01 hour vs. 8.40 ± 8.85 hour; p = .98).ConclusionThe LTVS, which was designed to treat wartime vascular injuries, might be safer and more efficient than the current TVS.

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Outcome after vascular trauma in a deployed military trauma system

Cited by 44 publications

References 17 publications

Anatomic distribution and mortality of arterial injury in the wars in Afghanistan and Iraq with comparison to a civilian benchmark

Anatomic distribution and mortality of arterial injury in the wars in Afghanistan and Iraq with comparison to a civilian benchmark

Reperfusion strategies in the management of extremity vascular injury with ischaemia

Locked Temporary Vascular Shunt for Wartime Vascular Injuries

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