title: Combat related vascular injuries: Dutch experiences from a role 2 MTF in Afghanistan.
abstract: BACKGROUND
  In a combat environment, major vascular trauma endures as the leading cause of death. The Dutch role 2 Medical Treatment Facility (MTF), provided supportive care during the mission in Uruzgan, Afghanistan. Aim of this study was to conduct detailed analysis of the admitted major haemorrhages (vascular injuries) and to compare our findings with NATO coalition partners.
  
  
  METHODS
  Retrospective, descriptive study. Participants eligible for this study came from the role 2 MTF admission database, where they fitted the criteria 'Major haemorrhage (class 2 haemorrhage or more according to the ATLS(®) classification) between 2006 and 2010'. Results were contrasted with studies from coalition partners.
  
  
  RESULTS
  The query revealed 194 casualties sustaining 208 central (60% abdominal, 40% thoracic/neck), and 99 extremity major haemorrhages leading to 1.6 major haemorrhages per casualty. Survival was significantly better (p<0.05) in the peripheral vascular injuries cohort (96% versus 72%). Primary amputation was needed in 73/84 of lower, and in 8/15 of upper extremity major haemorrhages. Vascular repair or vascular Damage Control Surgery techniques (e.g. shunting) were used in 19/84 cases in the lower, and 7/15 in the upper extremity cohort, with a success rate of 69.2 percent. Amputation rates of coalition partners, using different inclusion and exclusion criteria, ranged from 5 to 60 percent.
  
  
  CONCLUSIONS
  Only in a few cases genuine peripheral vascular surgery was needed (<1%). This limited number of reconstructions does not demonstrate the need for extensive skills in all areas of vascular surgery. Achieved success rate until discharge was almost 70%. Vascular damage control surgery seems effective as initial limb saving skill in a role 2 MTF. The difference in usage of definitions concerning vascular injuries in current literature warrants further assessment. For optimal analysis there is need for detailed (NATO wide) registration with uniform definitions for vascular injuries.
  
  
  METHODS
  Level IV--Epidemiologic study.
authors.affiliation: Department of Trauma, Division of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: thijsvandongen@ziggo.nl.
authors.forename: Thijs T C F
authors.initials: TT
authors.lastname: van Dongen
authors.affiliation: The Royal Netherlands Navy (R) and Department of Traumatology, Division of Surgery, Medical Center Haaglanden - Bronovo, The Hague, The Netherlands. Electronic address: f.idenburg@mchaaglanden.nl.
authors.forename: Floris J
authors.initials: FJ
authors.lastname: Idenburg
authors.affiliation: Royal Netherlands Army and Department of Surgery-Trauma, Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: edward.tan@radboudumc.nl.
authors.forename: Edward C T H
authors.initials: EC
authors.lastname: Tan
authors.affiliation: United States Air Force and The Norman M. Rich Department of Surgery, The Uniformed Services University of the Health Science, Bethesda, United States. Electronic address: todd.e.rasmussen.mil@mail.mil.
authors.forename: Todd E
authors.initials: TE
authors.lastname: Rasmussen
authors.affiliation: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: J.F.Hamming@lumc.nl.
authors.forename: Jaap F
authors.initials: JF
authors.lastname: Hamming
authors.affiliation: The Royal Netherlands Navy (R) and Department of Traumatology, Division of Surgery, Medical Center Haaglanden - Bronovo, The Hague, The Netherlands. Electronic address: l.p.h.leenen@umcutrecht.nl.
authors.forename: Luke P H
authors.initials: LP
authors.lastname: Leenen
authors.affiliation: The Royal Netherlands Navy (R) and Department of Traumatology, Division of Surgery, Medical Center Haaglanden - Bronovo, The Hague, The Netherlands. Electronic address: r.hoencamp@lumc.nl.
authors.forename: Rigo
authors.initials: R
authors.lastname: Hoencamp
mesh_terms: D055826:Afghan Campaign 2001-; D000346:Afghanistan / Q000453:epidemiology; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D001753:Blast Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006772:Hospitals, Military; D006801:Humans; D015601:Injury Severity Score; D008887:Military Medicine; D008889:Military Personnel; D009104:Multiple Trauma; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D057772:Vascular System Injuries / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*
keywords: Afghanistan; Military; Reconstruction; Repair; Shunt; Training; Vascular