World J Emerg Surg. 2013 Jul 01;8(1):22. doi: 10.1186/1749-7922-8-22.

Management of war-related vascular injuries: experience from the second gulf war.

World journal of emergency surgery : WJES

Ali Jawas, Alaa K Abbas, Munier Nazzal, Marzoog Albader, Fikri M Abu-Zidan

PMID: 23816260 PMCID: PMC3700839 DOI: 10.1186/1749-7922-8-22

Abstract

AIM: To study the biomechanism, pattern of injury, management, and outcome of major vascular injuries treated at Mubarak Al-Kabeer Teaching Hospital, Kuwait during the Second Gulf War.

METHODS: This is a descriptive retrospective study. War-related injured patients who had major vascular injuries and were treated at Mubarak Al-Kabeer Teaching Hospital from August 1990 to September 1991 were studied. Studied variables included age, gender, anatomical site of vascular injury, mechanism of injury, associated injuries, type of vascular repair, and clinical outcome.

RESULTS: 36 patients having a mean (SD) age of 29.8 (10.2) years were studied. 32 (89%) were males and 21 (58%) were civilians. Majority of injuries were caused by bullets (47.2%) and blast injuries (47.2%). Eight patients (22%) presented with shock.There were 31 arterial injuries, common and superficial femoral artery injuries were most common (10/31). Arterial repair included interposition saphenous vein graft in seven patients, thrombectomy with end-to-end / lateral repair in twelve patients, vein patch in two patients, and arterial ligation in four patients. Six patients had arterial ligation as part of primary amputation. 3/21 (14.3%) patients had secondary amputation after attempted arterial vascular repair of an extremity. There were a total of 17 venous injuries, 13 managed by lateral suture repair and 4 by ligation. The median (range) hospital stay was 8 (1-76) days. 5 patients died (14%).

CONCLUSIONS: Major vascular injuries occurred in 10% of hospitalized war-related injured patients. Our secondary amputation rate of extremities was 14%. The presence of a vascular surgeon within a military surgical team is highly recommended. Basic principles and techniques of vascular repair remain an essential part of training general surgeons because it may be needed in unexpected wars.

References

1. J Trauma. 2006 Jul;61(1):8-12; discussion 12-5 - PubMed
2. Ann R Coll Surg Engl. 1991 Jan;73(1):21-5 - PubMed
3. J Trauma. 1988 Jan;28(1 Suppl):S83-5 - PubMed
4. Scand J Surg. 2009;98(1):41-7 - PubMed
5. Eur J Surg. 2002;168(11):626-30 - PubMed
6. J Trauma. 1988 May;28(5):660-3 - PubMed
7. J Trauma. 1988 Apr;28(4):523-5 - PubMed
8. Ann R Coll Surg Engl. 1994 Nov;76(6):407-11 - PubMed
9. Am J Surg. 1997 Feb;173(2):110-4 - PubMed
10. Crit Care Med. 2008 Jul;36(7 Suppl):S304-10 - PubMed
11. World J Emerg Surg. 2010 May 19;5:13 - PubMed
12. Surgery. 1969 Jan;65(1):218-26 - PubMed
13. J Trauma. 2009 May;66(5):1468-77; discussion 1477 - PubMed
14. J Emerg Trauma Shock. 2011 Apr;4(2):173-7 - PubMed
15. J Emerg Trauma Shock. 2012 Jan;5(1):70-1 - PubMed
16. J Trauma. 2006 Feb;60(2):432-42 - PubMed
17. J Vasc Surg. 2005 Apr;41(4):638-44 - PubMed
18. J Trauma. 1992 Oct;33(4):532-6; discussion 536-8 - PubMed
19. Ann Vasc Surg. 2003 Nov;17(6):678-81 - PubMed
20. J Vasc Surg. 2008 Jun;47(6):1259-64; discussion 1264-5 - PubMed
21. Surg Clin North Am. 2001 Dec;81(6):1199-215 - PubMed
22. J Vasc Surg. 2001 Jun;33(6):1212-9 - PubMed
23. Mt Sinai J Med. 2004 Jan;71(1):4-11 - PubMed

Publication Types

• Journal Article