title: VA Vascular Injury Study (VAVIS): VA-DoD extremity injury outcomes collaboration.
abstract: BACKGROUND
  Limb injuries comprise 50-60% of U.S. Service member's casualties of wars in Afghanistan and Iraq. Combat-related vascular injuries are present in 12% of this cohort, a rate 5 times higher than in prior wars. Improvements in medical and surgical trauma care, including initial in-theatre limb salvage approaches (IILS) have resulted in improved survival and fewer amputations, however, the long-term outcomes such as morbidity, functional decline, and risk for late amputation of salvaged limbs using current process of care have not been studied. The long-term care of these injured warfighters poses a significant challenge to the Department of Defense (DoD) and Department of Veterans Affairs (VA).
  
  
  METHODS
  The VA Vascular Injury Study (VAVIS): VA-DoD Extremity Injury Outcomes Collaborative, funded by the VA, Health Services Research and Development Service, is a longitudinal cohort study of Veterans with vascular extremity injuries. Enrollment will begin April, 2015 and continue for 3 years. Individuals with a validated extremity vascular injury in the Department of Defense Trauma Registry will be contacted and will complete a set of validated demographic, social, behavioral, and functional status measures during interview and online/ mailed survey. Primary outcome measures will: 1) Compare injury, demographic and geospatial characteristics of patients with IILS and identify late vascular surgery related limb complications and health care utilization in Veterans receiving VA vs. non-VA care, 2) Characterize the preventive services received by individuals with vascular repair and related outcomes, and 3) Describe patient-reported functional outcomes in Veterans with traumatic vascular limb injuries.
  
  
  CONCLUSIONS
  This study will provide key information about the current process of care for Active Duty Service members and Veterans with polytrauma/vascular injuries at risk for persistent morbidity and late amputation. The results of this study will be the first step for clinicians in VA and military settings to generate evidence-based treatment and care approaches to these injuries. It will identify areas where rehabilitation medicine and vascular specialty care or telehealth options are needed to allow for better planning, resource utilization, and improved DoD-to-VA care transitions.
authors: Department of Surgery, Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center San Antonio, The South Texas Veterans Health Care System, 7703 Floyd Curl Drive, MC 7790, San Antonio, TX, 78229-3900, USA. Shireman@uthscsa.edu.
authors: Paula K
authors: PK
authors: Shireman
authors: US Combat Casualty Care Research Program, Fort Detrick, Frederick, MD, 21702-5012, USA. todd.e.rasmussen.mil@mail.mil.|The Uniformed Services University, Bethesda, MD, 20814, USA. todd.e.rasmussen.mil@mail.mil.
authors: Todd E
authors: TE
authors: Rasmussen
authors: Department of Rehabilitation Medicine, University of Texas Health Science Center San Antonio, Polytrauma Rehabilitation Center, South Texas Veterans Healthcare System, 7400 Merton Minter BLVD, San Antonio, TX, 78229, USA. Jaramilloc3@uthscsa.edu.
authors: Carlos A
authors: CA
authors: Jaramillo
authors: Department of Epidemiology and Biostatistics, University of Texas Health Science Center San Antonio, The South Texas Veterans Health Care System, 7400 Merton Minter BLVD, San Antonio, TX, 78229, USA. maryjo.pugh2@va.gov.
authors: Mary Jo
authors: MJ
authors: Pugh
mesh_terms: D000671:Amputation, Surgical; D002985:Clinical Protocols; D005121:Extremities / Q000098:blood supply / Q000293:injuries* / Q000601:surgery; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D023821:Limb Salvage; D008137:Longitudinal Studies; D010043:Outcome and Process Assessment, Health Care; D063868:Patient Outcome Assessment; D011183:Postoperative Complications / Q000175:diagnosis; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs; D014656:Vascular Surgical Procedures; D057772:Vascular System Injuries / Q000601:surgery*; D058014:Veterans Health; D000067398:War-Related Injuries / Q000601:surgery*
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