Abstract
Vascular injuries of the limbs are common in armed conflicts and they are the main cause of severe bleeding, ischemia, amputations, and death. Vascular injuries may be caused by blunt trauma, but more often they are the result of penetrating fragments, bullets, and recently by ball bearings, foreign bodies, and high explosives. Vascular injuries take priority in treatment paradigms since shortening of the time of bleeding and the time of ischemia are of paramount importance in saving limbs and lives of the injured. In the battlefield and during evacuation, rubber and improvised tourniquets are used to stop life threatening bleeding, but in the setting of the operating room these should be taken off as soon as feasible, to prevent continued ischemia of nerves and other soft tissues. Identification of the specific injured arteries and veins allows accurate clamping and appropriate repair of the involved vessels. Use of fasciotomies in this setting should be liberal to improve functional outcome. Primary repairs of vessels and use of autologous veins are preferred over synthetic grafts because of a greater risk of infection and thrombosis. In modern specialized vascular facilities, the success rate of repairs of combat vascular injuries is high, and mortality and amputation rates are low and continue to decrease.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
DeBakey, M.E., Simeone, F.A.: Battle injuries in World War II: an analysis of 2,471 cases. Ann. Surg. 123, 534–579 (1946)
Rich, N.M., Hughes, C.W.: Vietnam vascular registry: a preliminary report. Surgery 62, 218–226 (1969)
Clouse, W.D., Rasmussen, T.E., Eliason, P.M.A., JL, C.M.W., Bowser, A.N., Jenkins, D.H., Smith, D.L., Rich, N.M.: In-theater management of vascular injury: 2 years of the Balad vascular registry. J. Am. Coll. Surg. 204, 625–632 (2007)
Starnes, B.W., Beekley, A.C., Sebesta, J.A., Andersen, C.A., Rush, R.M.: Extremity injuries on the battlefield: tips for surgeons deploying to war. J. Trauma 60, 432–442 (2006)
Nitecki, S.S., Karram, T., Ofer, A., Engel, A., Hoffman, A.: Vascular injuries in an urban combat setting: experience from the 2006 Lebanon war. Vascular 18(1), 1–8 (2010)
Beekley, A.C., Sebesta, J.A., Blackbourne, L.H., Herbert, G.S., Kauvar, D.S., Baer, D.G., Walters, T.J., Mullenix, P.S., Holcomb, J.B.: 31st Combat Support Hospital Research Group, Prehospital tourniquet use in Operation Iraqi Freedom: effect on hemorrhage control and outcomes. J. Trauma 64(2 Suppl), S28–S37 (2008). discussion S37
Tien, H.C., Jung, V., Rizoli, S.B., Acharya, S.V., MacDonald, J.C.: An evaluation of tactical combat casualty care interventions in a combat environment. J. Am. Coll. Surg. 207(2), 174–178 (2008)
Fox, C.J., Starnes, B.W.: Vascular surgery on the modern battlefield. Surg. Clin. North Am. 87, 1193–1211 (2007)
Fleiter, T.R., Mervis, S.: The role of 3D-CTA in the assessment of peripheral vascular lesion in trauma patients. Eur. J. Radiol. 64, 92–102 (2007)
Miller-Thomas, M.M., West, O.C., Cohen, A.M.: Diagnosing traumatic arterial injury in the extremities with CT angiography: pearls and pitfalls. Radiographics 25(Suppl 1), S133–S142 (2005)
Eger, M., Golcman, L., Goldstein, A., Hirsch, M.: The use of a temporary shunt in the management of arterial vascular injuries. Surg. Gynecol. Obstet. 132, 67–70 (1971)
Gifford, S.M., Eliason, J.L., Clouse, W.D., Spencer, J.R., Burkhardt, G.E., Propper, B.W., Dixon, P.S., Zarzabal, L.A., Gelfond, J.A., Rasmussen, T.E.: Early versus delayed restoration of flow with temporary vascular shunt reduces circulating markers of injury in a porcine model. J. Trauma 67, 259–265 (2009)
Chambers, L.W., GreenDJ, S.K., Gillingham, B.L., Rhee, P., Brown, C., Narine, N., Uecker, J.M., Bohman, H.R.: Tactical surgical intervention with temporary shunting of peripheral vascular trauma sustained during operation Iraqi freedom: one unit’s experience. J. Trauma 61(4), 824–830 (2006)
Rasmussen, T.E., Clouse, W.D., Jenkins, D.H., Peck, M.A., Eliason, J.L., Smith, D.L.: The use of temporary vascular shunts as a damage control adjunct in the management of wartime vascular injury. J. Trauma 61, 8–12 (2006)
Subramanian, A., Vercruysse, G., Dente, C., Wyrzykowski, A., King, E., Feliciano, D.V.: A decade’s experience with temporary intravascular shunts at a civilian level I trauma center. J. Trauma 65, 316–324 (2008)
Taller, J., Kamdar, J.P., Greene, J.A., Morgan, R.A., Blankenship, C.L., Dabrovski, P., Sharpe, R.P.: Temporary vascular shunts as initial treatment of proximal extremity vascular injuries during combat operations: the new standarf of care at Echlon II facilities? J. Trauma 65, 595–603 (2008)
Arató, E., Kürthy, M., SÃnay, L., Kasza, G., Menyhei, G., Masoud, S., Bertalan, A., Verzár, Z., Kollár, L., Roth, E., Jancsó, G.: Pathology and diagnostic options of lower limb compartment syndrome. Clin. Hemorheol. Microcirc. 41(1), 1–8 (2009)
Dente, C.J., Feliciano, D.V., Rozycki, G.S., Cava, R.A., Ingram, W.L., Salomone, J.P., Nicholas, J.M., Kanakasundaram, D., Ansley, J.P.: A review ofupper extremity fasciotomies in a level I trauma center. Am. Surg. 70(12), 1088–1093 (2004)
Misovic, S., Ignjatovic, D., Jevtic, M., Tomic, A.: Extended ankle and foot fasciotomy as an enhancement to the surgical treatment of patients with prolonged ischemia of the lower extremities. Vojnosanit. Pregl. 62(4), 323–327 (2005). Serbian
Oredsson, S., Plate, G., Qvarfordt, P.: The effect of mannitol on reperfusion injury and postischaemic compartment pressure in skeletal muscle. Eur. J. Vasc. Surg. 8(3), 326–331 (1994)
Mullins, R.J., Lucas, C.E., Ledgerwood, A.M.: The natural history following venous ligation for civilian injuries. J. Trauma 20, 737–743 (1980)
Rich, N.M., Hughes, C.W., Baugh, J.H.: Management of venous injuries. Ann. Surg. 171, 724–730 (1970)
Timberlake, G.A., Kerstein, M.D.: Venous injury: to repair or ligate, the dilemma revisited. Am. Surg. 61, 139–145 (1995)
Nitecki, S.S., Karram, T., Hoffman, A., Bass, A.: Venous trauma in the Lebanon war. Interact. Cardiovasc. Thorac. Surg. 6(5), 647–650 (2006)
Fox, C.J., Gillespie, D.L., Cox, E.D., Mehta, S.G., Kragh, J.F., Salinas, J., Holcomb, J.B.: The effectiveness of a damage control resuscitation strategy for vascular injury in a combat support hospital: results of a case control study. J. Trauma 64, S99–S106 (2008)
Fox, C.J., Gillespie, D.L., O’Donnell, S.D., Rasmussen, T.E., Goff, J.M., Johnson, C.A., Galgon, R.E., Sarac, T.P., Rich, N.M.: Contemporary management of wartime vascular trauma. J. Vasc. Surg. 41, 638–644 (2005)
Lerner, A., Fodor, L., Soudry, M.: Is staged external fixation a valuable strategy for war injuries to the limbs ? Clin. Orthop. Relat. Res. 448, 217–224 (2006)
Rush Jr., R.M., Kjorstad, R., Starnes, B.W., Arrington, E., Devine, J.D., Andersen, C.A.: Application of the mangled extremity severity score in a combat setting. Mil. Med. 172(7), 777–781 (2007)
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer Berlin Heidelberg
About this chapter
Cite this chapter
Hoffman, A., Nitecki, S.S. (2011). Vascular Trauma to the Limbs. In: Lerner, A., Soudry, M. (eds) Armed Conflict Injuries to the Extremities. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-16155-1_11
Download citation
DOI: https://doi.org/10.1007/978-3-642-16155-1_11
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-16154-4
Online ISBN: 978-3-642-16155-1
eBook Packages: MedicineMedicine (R0)