title: A decade of pelvic vascular injuries during the Global War on Terror.
abstract: Pelvic vascular injuries (PVIs) rarely occur in isolation and are often associated with significant morbidity. The purpose of this study was to examine the incidence, trends, and early outcomes of PVIs sustained in combat.
  
  
  
  The Department of Defense Trauma Registry was queried to identify all patients treated with PVIs during the first 10 years of Operation Enduring Freedom. Patient demographics, mechanism of injury, type of vascular injury, in-theater complications, and early clinical outcomes were examined.
  
  
  
  From 2003 to 2012, 143 patients (99% male) sustained a PVI in Afghanistan. During this period, there was a persistent increase in the percentage of patient visits (0.4% in 2003 to 2.0% in 2012). The mean Injury Severity Score (ISS) was 24. Sixty-six percent of patient injuries were secondary to explosions. Improvised explosive devices (IEDs) encountered by dismounted personnel accounted for 47% of all injuries and were associated with a significantly higher ISS (28) compared with all other mechanisms of injury (P < .01). There were 85 (43%) arterial and 112 (57%) venous PVIs. The most frequent arterial injury was the common iliac artery. Injury to the femoral vein was associated with a higher median transfusion requirement. One patient died in combat theater. Injuries from IEDs had higher rates of coagulopathy, acidosis, and hypothermia compared with other mechanisms of injury (P = .03). Forty-two patients (29%) sustained early infectious complications. Injuries from explosions were also associated with a significantly higher rate of infectious complications compared with other mechanisms of injury (P < .01).
  
  
  
  PVIs have occurred with increasing frequency during Operation Enduring Freedom. Despite a persistently low mortality, complication and infection rates remain high, particularly when injuries are secondary to explosions. IEDs are associated with higher ISS and complication rates. Future studies must continue to focus on the prevention and treatment of PVIs sustained in combat, particularly those caused by explosions.
authors.affiliation: Naval Medical Center San Diego, San Diego, Calif.
authors.forename: Victoria S
authors.initials: VS
authors.lastname: McDonald
authors.affiliation: Naval Medical Center San Diego, San Diego, Calif.
authors.forename: Jacob
authors.initials: J
authors.lastname: Quail
authors.affiliation: Naval Medical Center San Diego, San Diego, Calif.
authors.forename: Marlon
authors.initials: M
authors.lastname: Tingzon
authors.affiliation: Naval Medical Center San Diego, San Diego, Calif.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Ayers
authors.affiliation: Naval Medical Center San Diego, San Diego, Calif. Electronic address: kevin.m.casey28.mil@mail.mil.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Casey
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D001753:Blast Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D054042:Bombs; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008887:Military Medicine; D010388:Pelvis / Q000098:blood supply*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D057772:Vascular System Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D000067398:War-Related Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery