The effect of vein repair on the risk of venous thromboembolic events: a review of more than 100 traumatic military venous injuries.
BACKGROUND
The management of venous trauma remains controversial. Critics of venous repair have cited an increased incidence of associated venous thromboembolic events with this management. We analyzed the current treatment of wartime venous injuries in United States military personnel in an effort to answer this question.


METHODS
From December 1, 2001, to October 31, 2005, all United States casualties with named venous injuries were evaluated. A retrospective review of a clinical database was performed on demographics, mechanism of injury, associated injuries, treatment, outcomes, and venous thromboembolic events. Data were analyzed using the Fisher exact test, analysis of variance, and logarithmic transformation.


RESULTS
During this 5-year period, 82 patients sustained 103 named venous injuries due to combat operations. All patients were male, with an average age of 27.9 years (range, 20.3-58.3 years). Blast injuries accounted for 54 venous injuries (65.9%), gunshot wounds for 25 (30.5%), and motor vehicle accidents for 3 (3.6%). The venous injury was isolated in 28 patients (34.1%), and 16 (19.5%) had multiple venous injuries. The venous injury in two patients was associated with acute phlegmasia, with fractures in 33 (40.2%), and 22 (28.1%) sustained neurologic deficits. Venous injuries were treated by ligation in 65 patients (63.1%) and by open surgical repair in 38 (36.9%). Postoperative extremity edema occurred in all patients irrespective of method of management. Thrombosis after venous repair occurred in six of the 38 cases (15.8%). Pulmonary emboli developed in three patients, one after open repair and two after ligation (P > .99).


CONCLUSIONS
In the largest review of military venous trauma in more than three decades, we found no difference in the incidence of venous thromboembolic complications between venous injuries managed by open repair vs ligation. Blast injuries of the extremities have caused most of the venous injuries. Ligation is the most common modality of treatment in combat zones. Long-term morbidity associated with venous injuries and their management will be assessed in future follow-up studies.
Quan
Reagan W
RW
Division of Vascular and Endovascular Surgery, Department of Surgery, Walter Reed Army Medical Center, Washington, DC 20307, USA. reagan.quan@us.army.mil
Gillespie
David L
DL
Stuart
Rory P
RP
Chang
Audrey S
AS
Whittaker
David R
DR
Fox
Charles J
CJ
D000063:Accidents, Traffic; D000328:Adult; D000346:Afghanistan; D000925:Anticoagulants / Q000627:therapeutic use; D001753:Blast Injuries / Q000601:surgery; D004487:Edema / Q000209:etiology; D006801:Humans; D015994:Incidence; D007493:Iraq; D008026:Ligation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D008887:Military Medicine / Q000706:statistics & numerical data; D008889:Military Personnel / Q000706:statistics & numerical data; D009104:Multiple Trauma / Q000601:surgery; D010690:Phlebography; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D012189:Retrospective Studies; D018570:Risk Assessment; D013530:Surgical Wound Infection / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000706:statistics & numerical data; D014680:Veins / Q000293:injuries / Q000601:surgery* / Q000637:transplantation; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D014947:Wounds and Injuries / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*; D014948:Wounds, Gunshot / Q000601:surgery
D000925:Anticoagulants