In-theater management of vascular injury: 2 years of the Balad Vascular Registry.
BACKGROUND
Wartime vascular injury management has traditionally advanced vascular surgery. Despite past military experience, and recent civilian publications, there are no reports detailing current in-theater treatment. The objective of this analysis is to describe the management of vascular injury at the central echelon III surgical facility in Iraq, and to place this experience in perspective with past conflicts.


METHODS
Vascular injuries evaluated at our facility between September 1, 2004 and August 31, 2006 were prospectively entered into a registry and reviewed.


RESULTS
During this 24-month period, 6,801 battle-related casualties were assessed. Three hundred twenty-four (4.8%) were diagnosed with 347 vascular injuries. Extremity injuries accounted for 260 (74.9%). Vascular injuries in the neck (n = 56; 16.1%) and thoracoabdominal domain (n = 31; 8.9%) were less common. US forces accounted for 149 casualties (46%), 97 (30%) were local civilian, and 78 (24%) were Iraqi forces. One hundred seven (33%) patients with vascular injury were evacuated from forward locations after treatment initiation. Fifty-four (50%) of these had temporary shunts placed. Of 43 proximal shunts placed in-field, 37 (86%) were patent at the time of our assessment. Early amputation rate was 6.6% for those extremity injuries treated for limb salvage. Perioperative mortality was 4.3%.


CONCLUSIONS
This evaluation represents the first in-theater report of wartime vascular injury since Vietnam. Extremity injuries continue to predominate, although the incidence of vascular injury appears to be somewhat increased. Local forces and civilians now represent a substantial proportion of those injured. The principles of rapid evacuation, temporary shunting, and early reconstruction are effective, with satisfactory early in-theater limb salvage.
Clouse
W Darrin
WD
332nd Expeditionary Medical Group, Air Force Theater Hospital, Balad Air Base, Iraq. william.clouse@lackland.af.mil
Rasmussen
Todd E
TE
Peck
Michael A
MA
Eliason
Jonathan L
JL
Cox
Mitchell W
MW
Bowser
Andrew N
AN
Jenkins
Donald H
DH
Smith
David L
DL
Rich
Norman M
NM
D001808:Blood Vessels / Q000293:injuries* / Q000473:pathology; D006772:Hospitals, Military; D006801:Humans; D007493:Iraq; D012042:Registries; D014481:United States; D014656:Vascular Surgical Procedures; D014857:Warfare