Management of Vascular Trauma during the Paris Terrorist Attack of November 13, 2015.
BACKGROUND
On November 13, 2015, Paris and Saint-Denis were the targets of terrorist attacks. The Public Hospitals of Paris Organization and the Percy Armed Forces Instruction Hospitals were mobilized to face the mass casualty situation. The objective of this study is to analyze the management of the victims presenting with a nonthoracic vascular trauma (NTVT).


METHODS
All the data relating to the victims of NTVT who required a specific vascular open or endovascular treatment were analyzed retrospectively. A 6-month follow-up was obtained for all the patients.


RESULTS
Among the 351 wounded, 20 (5.7%) patients had an NTVT and were dispatched in 8 hospitals (11 men of average age 32). NTVTs were gunshots in 17 cases (85%) or due to a handmade bomb in 3 cases (15%). Twelve patients (60%) received cardiopulmonary resuscitation during prehospital care. NTVT affected the limbs (14 cases, 70%) and the abdomen or the small pelvis (6 cases, 30%). All the patients were operated in emergency. Arterial lesions were treated with greater saphenous vein bypasses, by ligation, and/or embolization. Eleven venous lesions were treated by direct repair or ligation. Associated lesions requiring a specific treatment were present in 19 patients (95%) and were primarily osseous, nervous, and abdomino-pelvic. Severe postoperative complications were observed in 9 patients (45%). Fourteen patients (70%) required blood transfusion (6.4 U of packed red blood cells on average, range 0-48). There were no deaths or amputation and all vascular reconstructions were patent at 6 months.


CONCLUSIONS
The effectiveness of the prehospital emergency services and a multisite and multidisciplinary management made it possible to obtain satisfactory results for NTVT casualties. All the departments of vascular surgery must be prepared to receive many wounded victims in the event of terrorist attacks.
Service de Chirurgie Vasculaire, Hôpital de la Pitié-Salpêtrière, AP-HP, Faculté de Médecine Pierre et Marie Curie, Université Paris 6, Paris, France.
Philippe
P
Tresson
Service de Chirurgie Vasculaire, Hôpital Henri-Mondor, AP-HP, UPEC, Créteil, France.
Joseph
J
Touma
Service de Chirurgie Vasculaire, Hôpital de la Pitié-Salpêtrière, AP-HP, Faculté de Médecine Pierre et Marie Curie, Université Paris 6, Paris, France.
Julien
J
Gaudric
Service de Chirurgie Vasculaire et Thoracique, Hôpital Bichat, AP-HP, Faculté de Médecine Denis Diderot, Université Paris 7, Paris, France.
Quentin
Q
Pellenc
Service de Chirurgie Thoracique et Vasculaire, Hôpital Tenon, AP-HP, Faculté de Médecine Pierre et Marie Curie, Université Paris 6, Paris, France.
Marielle
M
Le Roux
Service de Chirurgie Vasculaire, Hôpital d'Instruction des Armées de Percy, Clamart, France.
Charles
C
Pierret
Service de Radiologie, Hôpital Henri-Mondor, AP-HP, UPEC, Créteil, France.
Hicham
H
Kobeiter
Service de Chirurgie Vasculaire, Hôpital Européen Georges-Pompidou, AP-HP, Faculté de Médecine Paris Descartes, Université Paris 5, Paris, France.
Pierre
P
Julia
Service de Chirurgie Vasculaire, Hôpital Ambroise-Paré, AP-HP, Boulogne-Billancourt, Université de Versailles Saint Quentin en Yvelines, Versailles, France.
Olivier
O
Goeau-Brissonniere
Service de Chirurgie Vasculaire, Hôpital Henri-Mondor, AP-HP, UPEC, Créteil, France.
Pascal
P
Desgranges
Service de Chirurgie Vasculaire, Hôpital de la Pitié-Salpêtrière, AP-HP, Faculté de Médecine Pierre et Marie Curie, Université Paris 6, Paris, France.
Fabien
F
Koskas
Service de Chirurgie Vasculaire et Thoracique, Hôpital Bichat, AP-HP, Faculté de Médecine Denis Diderot, Université Paris 7, Paris, France. Electronic address: yves.castier@bch.aphp.fr.
Yves
Y
Castier
D000328:Adult; D001753:Blast Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D001803:Blood Transfusion; D054042:Bombs; D019033:Delivery of Health Care, Integrated; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D004630:Emergencies; D004632:Emergency Medical Services; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D053834:Explosive Agents; D005260:Female; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D010297:Paris; D010348:Patient Care Team; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation; D023481:Terrorism; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult
D053834:Explosive Agents