Thoracic Vascular Injuries: Operative Management in “Enemy” Territory

Abstract

Thoracic injuries in general are not uncommon injuries following combat trauma. Despite this prevalence, however, the majority of patients presenting with chest trauma will not require thoracic operative intervention. Appropriate utilization of tube thoracostomy and comprehensive inpatient management will prove definitive treatment for the majority of patients with these injuries. Patients with confirmed vascular thoracic injury are, in contrast, often a different story. Vascular trauma in the thorax, particularly aortic and great vessel injuries, continues to be associated with high mortality. In fact, many patients with these injuries are not likely to survive to reach a facility capable of providing care. Among those that do make it to care, effective treatment mandates rapid but careful consideration of treatment dilemmas, thoughtful decision-making, a comprehensive appreciation of anatomic relationships within the thoracic cavity, and prompt operative intervention when indicated. Operative treatment, the focus of this chapter, has changed considerably within the last decade or more. Although endovascular technologies have significantly altered the manner in which these injuries are managed in the civilian setting, open surgical management approaches remain the foundation of combat casualty care.