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Vascular Trauma

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Reconstructing the War Injured Patient

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Abstract

Wartime vascular injury adds another dimension to the challenging management of vascular trauma. The ABCs of trauma guide the management with a special attention to controlling exsanguinating hemorrhage. Patients with wartime vascular trauma typically present with hard signs of vascular injury and are best managed with prompt exploration. Patients with soft signs are evaluated clinically and would benefit from CT angiography if available to further guide the management. Proximal and distal control are essential prior to exploring the injured area and exploring the missile trajectory. In unstable patients with multiple injuries a temporary shunt may be necessary to maintain the circulation while other life-threatening injuries are being addressed. Otherwise the injured area is debrided and reconstructed based on the degree of injury. An autogenous vein from the contralateral extremity is often used if the patient is stable. In unstable patients, prosthetic PTFE grafts have been used successfully even in the presence of contamination. Bypasses may be tunneled in a non-anatomic way to avoid a contaminated field. The extent and duration of ischemia greatly impact the outcome of the management. Furthermore, associated soft tissue injury is a major factor that affects the final outcome. Coverage of the vascular reconstruction with vascularized tissue is an essential principle to avoid infection and blowout of the suture lines. Throughout the management, the life before limb principle is strictly adhered to. Unstable patients with massive soft tissue and bony destruction may be best served with a primary amputation.

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References

  1. Starnes BW, Beekley AC, Sebesta JA, Andersen CA, Rush Jr RM. Extremity vascular injuries on the battlefield: tips for surgeons deploying to war. J Trauma. 2006;60(2):432–42.

    Article  PubMed  Google Scholar 

  2. Schiro GR, Sessa S, Piccioli A, Maccauro G. Primary amputation vs limb salvage in mangled extremity: a systematic review of the current scoring system. BMC Musculoskelet Disord. 2015;16:372.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. Sauer SW, Robinson JB, Smith MP, Gross KR, Kotwal RS, Mabry RL, et al. Saving lives on the battlefield (part II)? One year later a joint theater trauma system and joint trauma system review of prehospital trauma care in combined joint operations area? Afghanistan (CJOA-A) Final Report, 30 May 2014. J Spec Oper Med. 2015;15(2):25–41.

    PubMed  Google Scholar 

  4. Kotwal RS, Butler FK, Montgomery HR, Brunstetter TJ, Diaz GY, Kirkpatrick JW, et al. The tactical combat casualty care casualty card TCCC guidelines? Proposed change 1301. J Spec Oper Med. 2013;13(2):82–7.

    PubMed  Google Scholar 

  5. Kotwal RS, Montgomery HR, Kotwal BM, Champion HR, Butler Jr FK, Mabry RL, et al. Eliminating preventable death on the battlefield. Arch Surg. 2011;146(12):1350–8.

    Article  PubMed  Google Scholar 

  6. Savage E, Forestier C, Withers N, Tien H, Pannell D. Tactical combat casualty care in the Canadian Forces: lessons learned from the Afghan war. Can J Surg. 2011;54(6):S118–23.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hooper TJ, Nadler R, Badloe J, Butler FK, Glassberg E. Implementation and execution of military forward resuscitation programs. Shock. 2014;41(Suppl 1):90–7.

    Article  PubMed  Google Scholar 

  8. Dua A, Patel B, Kragh Jr JF, Holcomb JB, Fox CJ. Long-term follow-up and amputation-free survival in 497 casualties with combat-related vascular injuries and damage-control resuscitation. J Trauma Acute Care Surg. 2012;73(6):1517–24.

    Article  PubMed  Google Scholar 

  9. Mabry RL. Tourniquet use on the battlefield. Mil Med. 2006;171(5):352–6.

    Article  PubMed  Google Scholar 

  10. Welling DR, Burris DG, Hutton JE, Minken SL, Rich NM. A balanced approach to tourniquet use: lessons learned and relearned. J Am Coll Surg. 2006;203(1):106–15.

    Article  PubMed  Google Scholar 

  11. Richey SL. Tourniquets for the control of traumatic hemorrhage: a review of the literature. J Spec Oper Med. 2009;9(1):56–64.

    PubMed  Google Scholar 

  12. Barr J, Cherry KJ, Rich NM. Vascular surgery in World War II: the shift to repairing arteries. Ann Surg. 2016;263(3):615–20.

    Article  PubMed  Google Scholar 

  13. Makin G. On gunshot injuries to the blood vessels. Founded on experience gained in France during the great war, 1914–1918. Bristol: John Wright and Sons, Ltd.; 1919.

    Google Scholar 

  14. DeBakey ME, Simeone FA. Battle injuries of the arteries in World War II: an analysis of 2,471 cases. Ann Surg. 1946;123(4):534.

    Article  PubMed Central  Google Scholar 

  15. Hughes CW. Arterial repair during the Korean War. Ann Surg. 1958;147(4):555.

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Rich NM, Baugh JH, Hughes CW. Acute arterial injuries in Vietnam: 1,000 cases. J Trauma. 1970;10(5):359–69.

    Article  CAS  PubMed  Google Scholar 

  17. Barros D’Sa AA. Twenty five years of vascular trauma in Northern Ireland. BMJ. 1995;310(6971):1–2.

    Article  PubMed  PubMed Central  Google Scholar 

  18. White JM, Stannard A, Burkhardt GE, Eastridge BJ, Blackbourne LH, Rasmussen TE. The epidemiology of vascular injury in the wars in Iraq and Afghanistan. Ann Surg. 2011;253(6):1184–9.

    Article  PubMed  Google Scholar 

  19. Jawas A, Abbas AK, Nazzal M, Albader M, Abu-Zidan FM. Management of war-related vascular injuries: experience from the second gulf war. World J Emerg Surg. 2013;8(1):22.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Woodward EB, Clouse WD, Eliason JL, Peck MA, Bowser AN, Cox MW, et al. Penetrating femoropopliteal injury during modern warfare: experience of the Balad Vascular Registry. J Vasc Surg. 2008;47(6):1259–64; discussion 64–5.

    Article  PubMed  Google Scholar 

  21. Chambers LW, Rhee P, Baker BC, Perciballi J, Cubano M, Compeggie M, et al. Initial experience of US Marine Corps forward resuscitative surgical system during Operation Iraqi Freedom. Arch Surg. 2005;140(1):26–32.

    Article  PubMed  Google Scholar 

  22. Rasmussen TE, Clouse WD, Jenkins DH, Peck MA, Eliason JL, Smith DL. Echelons of care and the management of wartime vascular injury: a report from the 332nd EMDG/Air Force Theater Hospital, Balad Air Base, Iraq. Perspect Vasc Surg Endovasc Ther. 2006;18(2):91–9.

    Article  PubMed  Google Scholar 

  23. Markov NP, DuBose JJ, Scott D, Propper BW, Clouse WD, Thompson B, et al. Anatomic distribution and mortality of arterial injury in the wars in Afghanistan and Iraq with comparison to a civilian benchmark. J Vasc Surg. 2012;56(3):728–36.

    Article  PubMed  Google Scholar 

  24. Fox CJ, Gillespie DL, Cox ED, Kragh Jr JF, Mehta SG, Salinas J, et al. Damage control resuscitation for vascular surgery in a combat support hospital. J Trauma. 2008;65(1):1–9.

    Article  PubMed  Google Scholar 

  25. Oller DW, Rutledge R, Clancy T, Cunningham P, Thomason M, Meredith W, et al. Vascular injuries in a rural state: a review of 978 patients from a state trauma registry. J Trauma. 1992;32(6):740–5; discussion 5–6.

    Article  CAS  PubMed  Google Scholar 

  26. Franz RW, Shah KJ, Halaharvi D, Franz ET, Hartman JF, Wright ML. A 5-year review of management of lower extremity arterial injuries at an urban level I trauma center. J Vasc Surg. 2011;53(6):1604–10.

    Article  PubMed  Google Scholar 

  27. Shin EH, Sabino JM, Nanos 3rd GP, Valerio IL. Ballistic trauma: lessons learned from Iraq and Afghanistan. Semin Plast Surg. 2015;29(1):10–9.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Bartlett CS, Helfet DL, Hausman MR, Strauss E. Ballistics and gunshot wounds: effects on musculoskeletal tissues. J Am Acad Orthop Surg. 2000;8(1):21–36.

    Article  CAS  PubMed  Google Scholar 

  29. Meyer JP, Lim LT, Schuler JJ, Castronuovo JJ, Buchbinder D, Woelfel GF, et al. Peripheral vascular trauma from close-range shotgun injuries. Arch Surg. 1985;120(10):1126–31.

    Article  CAS  PubMed  Google Scholar 

  30. Ordog GJ, Wasserberger J, Balasubramaniam S. Shotgun wound ballistics. J Trauma. 1988;28(5):624–31.

    Article  CAS  PubMed  Google Scholar 

  31. Ramasamy A, Hill AM, Masouros S, Gibb I, Phillip R, Bull AM, et al. Outcomes of IED foot and ankle blast injuries. J Bone Joint Surg Am. 2013;95(5):e25.

    Article  PubMed  Google Scholar 

  32. McDonald VS, Quail J, Tingzon M, Ayers JD, Casey KM. A decade of pelvic vascular injuries during the Global War on Terror. J Vasc Surg. 2016;63(6):1588–94.

    Article  PubMed  Google Scholar 

  33. Maiden N. Ballistics reviews: mechanisms of bullet wound trauma. Forensic Sci Med Pathol. 2009;5(3):204–9.

    Article  PubMed  Google Scholar 

  34. Fackler ML. Wounding patterns of military rifle bullets. Int Defense Rev. 1989;22(1):59–64.

    Google Scholar 

  35. Foster BR, Anderson SW, Uyeda JW, Brooks JG, Soto JA. Integration of 64-detector lower extremity CT angiography into whole-body trauma imaging: feasibility and early experience. Radiology. 2011;261(3):787–95.

    Article  PubMed  Google Scholar 

  36. Kauvar DS, Sarfati MR, Kraiss LW. National trauma databank analysis of mortality and limb loss in isolated lower extremity vascular trauma. J Vasc Surg. 2011;53(6):1598–603.

    Article  PubMed  Google Scholar 

  37. Vertrees A, Fox CJ, Quan RW, Cox MW, Adams ED, Gillespie DL. The use of prosthetic grafts in complex military vascular trauma: a limb salvage strategy for patients with severely limited autologous conduit. J Trauma. 2009;66(4):980–3.

    Article  CAS  PubMed  Google Scholar 

  38. Hafez HM, Woolgar J, Robbs JV. Lower extremity arterial injury: results of 550 cases and review of risk factors associated with limb loss. J Vasc Surg. 2001;33(6):1212–9.

    Article  CAS  PubMed  Google Scholar 

  39. Bishara RA, Pasch AR, Lim LT, Meyer JP, Schuler JJ, Hall Jr RF, et al. Improved results in the treatment of civilian vascular injuries associated with fractures and dislocations. J Vasc Surg. 1986;3(5):707–11.

    Article  CAS  PubMed  Google Scholar 

  40. Wani ML, Ahangar AG, Wani SN, Dar AM, Ganie FA, Singh S, et al. Peripheral vascular injuries due to blunt trauma (road traffic accident): management and outcome. Int J Surg. 2012;10(9):560–2.

    Article  PubMed  Google Scholar 

  41. Nehler MR, Taylor Jr LM, Porter JM. Iatrogenic vascular trauma. Semin Vasc Surg. 1998;11(4):283–93.

    CAS  PubMed  Google Scholar 

  42. Rich NM, Hobson 2nd RW, Fedde CW. Vascular trauma secondary to diagnostic and therapeutic procedures. Am J Surg. 1974;128(6):715–21.

    Article  CAS  PubMed  Google Scholar 

  43. Kalapatapu VR, Ali AT, Masroor F, Moursi MM, Eidt JF. Techniques for managing complications of arterial closure devices. Vasc Endovasc Surg. 2006;40(5):399–408.

    Article  Google Scholar 

  44. Tonnessen BH. Iatrogenic injury from vascular access and endovascular procedures. Perspect Vasc Surg Endovasc Ther. 2011;23(2):128–35.

    Article  PubMed  Google Scholar 

  45. Katzenschlager R, Ugurluoglu A, Ahmadi A, Hulsmann M, Koppensteiner R, Larch E, et al. Incidence of pseudoaneurysm after diagnostic and therapeutic angiography. Radiology. 1995;195(2):463–6.

    Article  CAS  PubMed  Google Scholar 

  46. Skillman JJ, Kim D, Baim DS. Vascular complications of percutaneous femoral cardiac interventions. Incidence and operative repair. Arch Surg. 1988;123(10):1207–12.

    Article  CAS  PubMed  Google Scholar 

  47. Hirano Y, Ikuta S, Uehara H, Nakamura H, Taniguchi M, Kimura A, et al. Diagnosis of vascular complications at the puncture site after cardiac catheterization. J Cardiol. 2004;43(6):259–65.

    PubMed  Google Scholar 

  48. Deziel DJ, Millikan KW, Economou SG, Doolas A, Ko ST, Airan MC. Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg. 1993;165(1):9–14.

    Article  CAS  PubMed  Google Scholar 

  49. Ahmad G, O’Flynn H, Duffy JM, Phillips K, Watson A. Laparoscopic entry techniques. Cochrane Database Syst Rev. 2012;(2):CD006583.

    Google Scholar 

  50. Chapron CM, Pierre F, Lacroix S, Querleu D, Lansac J, Dubuisson JB. Major vascular injuries during gynecologic laparoscopy. J Am Coll Surg. 1997;185(5):461–5.

    Article  CAS  PubMed  Google Scholar 

  51. Sandadi S, Johannigman JA, Wong VL, Blebea J, Altose MD, Hurd WW. Recognition and management of major vessel injury during laparoscopy. J Minim Invasive Gynecol. 2010;17(6):692–702.

    Article  PubMed  Google Scholar 

  52. Fuller J, Ashar BS, Carey-Corrado J. Trocar-associated injuries and fatalities: an analysis of 1399 reports to the FDA. J Minim Invasive Gynecol. 2005;12(4):302–7.

    Article  PubMed  Google Scholar 

  53. Bhoyrul S, Vierra MA, Nezhat CR, Krummel TM, Way LW. Trocar injuries in laparoscopic surgery. J Am Coll Surg. 2001;192(6):677–83.

    Article  CAS  PubMed  Google Scholar 

  54. McDonald PT, Rich NM, Collins Jr GJ, Andersen CA, Kozloff L. Vascular trauma secondary to diagnostic and therapeutic procedures: laparoscopy. Am J Surg. 1978;135(5):651–5.

    Article  CAS  PubMed  Google Scholar 

  55. Inamasu J, Guiot BH. Vascular injury and complication in neurosurgical spine surgery. Acta Neurochir. 2006;148(4):375–87.

    Article  CAS  PubMed  Google Scholar 

  56. Marsicano J, Mirovsky Y, Remer S, Bloom N, Neuwirth M. Thrombotic occlusion of the left common iliac artery after an anterior retroperitoneal approach to the lumbar spine. Spine. 1994;19(3):357–9.

    Article  CAS  PubMed  Google Scholar 

  57. Faciszewski T, Winter RB, Lonstein JE, Denis F, Johnson L. The surgical and medical perioperative complications of anterior spinal fusion surgery in the thoracic and lumbar spine in adults. A review of 1223 procedures. Spine. 1995;20(14):1592–9.

    Article  CAS  PubMed  Google Scholar 

  58. McDonnell MF, Glassman SD, Dimar 2nd JR, Puno RM, Johnson JR. Perioperative complications of anterior procedures on the spine. J Bone Joint Surg Am Vol. 1996;78(6):839–47.

    Article  CAS  Google Scholar 

  59. Hans SS, Shepard AD, Reddy P, Rama K, Romano W. Iatrogenic arterial injuries of spine and orthopedic operations. J Vasc Surg. 2011;53(2):407–13.

    Article  PubMed  Google Scholar 

  60. Scharnbacher J, Claus M, Reichert J, Rohrl T, Hoffmann U, Ulm K, et al. Hypothenar hammer syndrome: a multicenter case-control study. Am J Ind Med. 2013;56(11):1352–8.

    PubMed  Google Scholar 

  61. Ferris BL, Taylor Jr LM, Oyama K, McLafferty RB, Edwards JM, Moneta GL, et al. Hypothenar hammer syndrome: proposed etiology. J Vasc Surg. 2000;31(1 Pt 1):104–13.

    Article  CAS  PubMed  Google Scholar 

  62. Heaver C, Goonetilleke KS, Ferguson H, Shiralkar S. Hand-arm vibration syndrome: a common occupational hazard in industrialized countries. J Hand Surg Eur Vol. 2011;36(5):354–63.

    Article  CAS  PubMed  Google Scholar 

  63. Cooke RA. Hypothenar hammer syndrome: a discrete syndrome to be distinguished from hand-arm vibration syndrome. Occup Med (Lond). 2003;53(5):320–4.

    Article  CAS  Google Scholar 

  64. Cooke RA. Thoracic outlet syndrome—aspects of diagnosis in the differential diagnosis of hand-arm vibration syndrome. Occup Med (Lond). 2003;53(5):331–6.

    Article  CAS  Google Scholar 

  65. Davidovic LB, Kostic DM, Jakovljevic NS, Kuzmanovic IL, Simic TM. Vascular thoracic outlet syndrome. World J Surg. 2003;27(5):545–50.

    Article  PubMed  Google Scholar 

  66. Hood DB, Kuehne J, Yellin AE, Weaver FA. Vascular complications of thoracic outlet syndrome. Am Surg. 1997;63(10):913–7.

    CAS  PubMed  Google Scholar 

  67. Criado E, Berguer R, Greenfield L. The spectrum of arterial compression at the thoracic outlet. J Vasc Surg. 2010;52(2):406–11.

    Article  PubMed  Google Scholar 

  68. de Mooij T, Duncan AA, Kakar S. Vascular injuries in the upper extremity in athletes. Hand Clin. 2015;31(1):39–52.

    Article  PubMed  Google Scholar 

  69. Jackson MR. Upper extremity arterial injuries in athletes. Semin Vasc Surg. 2003;16(3):232–9.

    Article  PubMed  Google Scholar 

  70. Mariscalco MW, Saluan P. Upper extremity injuries in the adolescent athlete. Sports Med Arthrosc Rev. 2011;19(1):17–26.

    Article  Google Scholar 

  71. Nuber GW, McCarthy WJ, Yao JS, Schafer MF, Suker JR. Arterial abnormalities of the shoulder in athletes. Am J Sports Med. 1990;18(5):514–9.

    Article  CAS  PubMed  Google Scholar 

  72. ATLS Subcommittee; American College of Surgeons’ Committee on Trauma; International ATLS working group. Advanced trauma life support (ATLS®): the ninth edition. J Trauma Acute Care Surg. 2013;74(5):1363–6.

    Google Scholar 

  73. Ramasamy A, Midwinter M, Mahoney P, Clasper J. Learning the lessons from conflict: pre-hospital cervical spine stabilisation following ballistic neck trauma. Injury. 2009;40(12):1342–5.

    Article  PubMed  Google Scholar 

  74. Arishita GI, Vayer JS, Bellamy RF. Cervical spine immobilization of penetrating neck wounds in a hostile environment. J Trauma. 1989;29(3):332–7.

    Article  CAS  PubMed  Google Scholar 

  75. Feliciano DV. Management of peripheral arterial injury. Curr Opin Crit Care. 2010;16(6):602–8.

    Article  PubMed  Google Scholar 

  76. Barnes CJ, Pietrobon R, Higgins LD. Does the pulse examination in patients with traumatic knee dislocation predict a surgical arterial injury?. A meta-analysis. J Trauma. 2002;53(6):1109–14.

    Article  PubMed  Google Scholar 

  77. Miranda FE, Dennis JW, Veldenz HC, Dovgan PS, Frykberg ER. Confirmation of the safety and accuracy of physical examination in the evaluation of knee dislocation for injury of the popliteal artery: a prospective study. J Trauma. 2002;52(2):247–51; discussion 51–2.

    PubMed  Google Scholar 

  78. Frykberg ER, Dennis JW, Bishop K, Laneve L, Alexander RH. The reliability of physical examination in the evaluation of penetrating extremity trauma for vascular injury: results at one year. J Trauma. 1991;31(4):502–11.

    Article  CAS  PubMed  Google Scholar 

  79. Quail JF, McDonald VS, Carter KK, Weiss JS, Casey KM. A pulseless limb poorly predicts an arterial injury in combat trauma. Ann Vasc Surg. 2015;29(6):1097–104.

    Article  PubMed  Google Scholar 

  80. Espinosa GA, Chiu JC, Samett EJ. Clinical assessment and arteriography for patients with penetrating extremity injuries: a review of 500 cases with the Veterans Affairs West Side Medical Center. Mil Med. 1997;162(1):19–23.

    CAS  PubMed  Google Scholar 

  81. Dennis JW, Frykberg ER, Veldenz HC, Huffman S, Menawat SS. Validation of nonoperative management of occult vascular injuries and accuracy of physical examination alone in penetrating extremity trauma: 5- to 10-year follow-up. J Trauma. 1998;44(2):243–52; discussion 2–3.

    Google Scholar 

  82. Lynch K, Johansen K. Can Doppler pressure measurement replace “exclusion” arteriography in the diagnosis of occult extremity arterial trauma? Ann Surg. 1991;214(6):737–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  83. Mills WJ, Barei DP, McNair P. The value of the ankle-brachial index for diagnosing arterial injury after knee dislocation: a prospective study. J Trauma. 2004;56(6):1261–5.

    Article  PubMed  Google Scholar 

  84. Panetta TF, Hunt JP, Buechter KJ, Pottmeyer A, Batti JS. Duplex ultrasonography versus arteriography in the diagnosis of arterial injury: an experimental study. J Trauma. 1992;33(4):627–35; discussion 35–6.

    Google Scholar 

  85. DuBose JJ, Savage SA, Fabian TC, Menaker J, Scalea T, Holcomb JB, et al. The American Association for the Surgery of Trauma PROspective Observational Vascular Injury Treatment (PROOVIT) registry: multicenter data on modern vascular injury diagnosis, management, and outcomes. J Trauma Acute Care Surg. 2015;78(2):215–22; discussion 22–3.

    Google Scholar 

  86. Soto JA, Munera F, Morales C, Lopera JE, Holguin D, Guarin O, et al. Focal arterial injuries of the proximal extremities: helical CT arteriography as the initial method of diagnosis. Radiology. 2001;218(1):188–94.

    Article  CAS  PubMed  Google Scholar 

  87. Inaba K, Branco BC, Reddy S, Park JJ, Green D, Plurad D, et al. Prospective evaluation of multidetector computed tomography for extremity vascular trauma. J Trauma. 2011;70(4):808–15.

    Article  PubMed  Google Scholar 

  88. Wolinsky PR, Webb LX, Harvey EJ, Tejwani NC. The mangled limb: salvage versus amputation. Instr Course Lect. 2011;60:27–34.

    PubMed  Google Scholar 

  89. Fox CJ, Perkins JG, Kragh Jr JF, Singh NN, Patel B, Ficke JR. Popliteal artery repair in massively transfused military trauma casualties: a pursuit to save life and limb. J Trauma. 2010;69(Suppl 1):S123–34.

    Article  PubMed  Google Scholar 

  90. Anglen JO. Wound irrigation in musculoskeletal injury. J Am Acad Orthop Surg. 2001;9(4):219–26.

    Article  CAS  PubMed  Google Scholar 

  91. Casey K, Sabino J, Jessie E, Martin BD, Valerio I. Flap coverage outcomes following vascular injury and repair: chronicling a decade of severe war-related extremity trauma. Plast Reconstr Surg. 2015;135(1):301–8.

    Article  CAS  PubMed  Google Scholar 

  92. Sabino J, Polfer E, Tintle S, Jessie E, Fleming M, Martin B, et al. A decade of conflict: flap coverage options and outcomes in traumatic war-related extremity reconstruction. Plast Reconstr Surg. 2015;135(3):895–902.

    Article  CAS  PubMed  Google Scholar 

  93. Demiralp B, Yildirim C, Yurttas Y, Cicek EI, Basbozkurt M. Lower limb salvage surgery using Ilizarov circular external frame for a landmine injury about the knee. Eklem Hastalik Cerrahisi. 2013;24(1):41–5.

    Article  PubMed  Google Scholar 

  94. Connolly M, Ibrahim ZR, Johnson 3rd ON. Changing paradigms in lower extremity reconstruction in war-related injuries. Mil Med Res. 2016;3:9.

    Article  PubMed  PubMed Central  Google Scholar 

  95. Kovoor CC, George VV, Jayakumar R, Guild AJ, Bhaskar D, Cyriac A. Total and subtotal amputation of lower limbs treated by acute shortening, revascularization and early limb lengthening with ilizarov ring fixation—a retrospective study. Injury. 2015;46(10):1964–8.

    Article  CAS  PubMed  Google Scholar 

  96. Fowler J, Macintyre N, Rehman S, Gaughan JP, Leslie S. The importance of surgical sequence in the treatment of lower extremity injuries with concomitant vascular injury: a meta-analysis. Injury. 2009;40(1):72–6.

    Article  PubMed  Google Scholar 

  97. Halvorson JJ, Anz A, Langfitt M, Deonanan JK, Scott A, Teasdall RD, et al. Vascular injury associated with extremity trauma: initial diagnosis and management. J Am Acad Orthop Surg. 2011;19(8):495–504.

    Article  PubMed  Google Scholar 

  98. Martin RR, Mattox KL, Burch JM, Richardson RJ. Advances in treatment of vascular injuries from blunt and penetrating limb trauma. World J Surg. 1992;16(5):930–7.

    Article  CAS  PubMed  Google Scholar 

  99. Iannacone WM, Taffet R, DeLong Jr WG, Born CT, Dalsey RM, Deutsch LS. Early exchange intramedullary nailing of distal femoral fractures with vascular injury initially stabilized with external fixation. J Trauma Acute Care Surg. 1994;37(3):446–51.

    Article  CAS  Google Scholar 

  100. Fox LC, Kreishman MP. High-energy trauma and damage control in the lower limb. Semin Plast Surg. 2010;24(1):5–10.

    Article  PubMed  PubMed Central  Google Scholar 

  101. Clouse WD, Rasmussen TE, Peck MA, Eliason JL, Cox MW, Bowser AN, et al. In-theater management of vascular injury: 2 years of the Balad Vascular Registry. J Am Coll Surg. 2007;204(4):625–32.

    Article  PubMed  Google Scholar 

  102. Rasmussen TE, Clouse WD, Jenkins DH, Peck MA, Eliason JL, Smith DL. The use of temporary vascular shunts as a damage control adjunct in the management of wartime vascular injury. J Trauma. 2006;61(1):8–12; discussion 12–5.

    Google Scholar 

  103. Taller J, Kamdar JP, Greene JA, Morgan RA, Blankenship CL, Dabrowski P, et al. Temporary vascular shunts as initial treatment of proximal extremity vascular injuries during combat operations: the new standard of care at Echelon II facilities? J Trauma. 2008;65(3):595–603.

    Article  PubMed  Google Scholar 

  104. Borut LT, Acosta CJ, Tadlock LC, Dye JL, Galarneau M, Elshire CD. The use of temporary vascular shunts in military extremity wounds: a preliminary outcome analysis with 2-year follow-up. J Trauma. 2010;69(1):174–8.

    Article  PubMed  Google Scholar 

  105. Kruger A, Florido C, Braunisch A, Walther E, Yilmaz TH, Doll D. Penetrating arterial trauma to the limbs: outcome of a modified protocol. World J Emerg Surg. 2013;8(1):51.

    Article  PubMed  PubMed Central  Google Scholar 

  106. Baechler MF, Groth AT, Nesti LJ, Martin BD. Soft tissue management of war wounds to the foot and ankle. Foot Ankle Clin. 2010;15(1):113–38.

    Article  PubMed  PubMed Central  Google Scholar 

  107. Sabino JM, Slater J, Valerio IL. Plastic surgery challenges in War Wounded I: flap-based extremity reconstruction. Adv Wound Care. 2016;5(9):403–11.

    Article  Google Scholar 

  108. Eisenberg L, Paulson EK, Kliewer MA, Hudson MP, DeLong DM, Carroll BA. Sonographically guided compression repair of pseudoaneurysms: further experience from a single institution. AJR Am J Roentgenol. 1999;173(6):1567–73.

    Article  CAS  PubMed  Google Scholar 

  109. Coley BD, Roberts AC, Fellmeth BD, Valji K, Bookstein JJ, Hye RJ. Postangiographic femoral artery pseudoaneurysms: further experience with US-guided compression repair. Radiology. 1995;194(2):307–11.

    Article  CAS  PubMed  Google Scholar 

  110. Morgan R, Belli AM. Current treatment methods for postcatheterization pseudoaneurysms. J Vasc Interv Radiol. 2003;14(6):697–710.

    Article  PubMed  Google Scholar 

  111. Sanchez-Enciso MA, Nuno-Escobar C, Gonzalez-Ojeda A, Llamas-Macias FJ, Ramos-Lopez CR, Fuentes-Orozco C. Treatment of arterial pseudoaneurysms with percutaneous ultrasound-guided thrombin injection. Cir Cir. 2012;80(2):134–9.

    PubMed  Google Scholar 

  112. Heis HA, Bani-Hani KE, Elheis MA, Yaghan RJ, Bani-Hani BK. Postcatheterization femoral artery pseudoaneurysms: therapeutic options. A case-controlled study. Int J Surg. 2008;6(3):214–9.

    Article  PubMed  Google Scholar 

  113. Kruger K, Zahringer M, Sohngen FD, Gossmann A, Schulte O, Feldmann C, et al. Femoral pseudoaneurysms: management with percutaneous thrombin injections—success rates and effects on systemic coagulation. Radiology. 2003;226(2):452–8.

    Article  PubMed  Google Scholar 

  114. Nough H, Bagherinasab M, Emami M, Sarebanhassanabadi M, Hadiani L. Endovascular treatment of post-traumatic pseudoaneurysms of ulnar and radial artery. Acta Med Iran. 2014;52(11):865–7.

    PubMed  Google Scholar 

  115. Marino M, Kasemi H, Di Angelo CL, Fadda GF. Endovascular repair of a proximal ilio-iliac arterio-venous fistula and distal pseudoaneurysm of the hypogastric artery 23 years after penetrating trauma. Interact Cardiovasc Thorac Surg. 2015;21(2):269–71.

    Article  PubMed  Google Scholar 

  116. Assali AR, Sdringola S, Moustapha A, Rihner M, Denktas AE, Lefkowitz MA, et al. Endovascular repair of traumatic pseudoaneurysm by uncovered self-expandable stenting with or without transstent coiling of the aneurysm cavity. Catheter Cardiovasc Interv. 2001;53(2):253–8.

    Article  CAS  PubMed  Google Scholar 

  117. Franz RW, Jump MA. Endovascular repair of post-traumatic, concomitant popliteal artery pseudoaneurysm and arteriovenous fistula. Int J Angiol. 2009;18(1):41–4.

    Article  PubMed  PubMed Central  Google Scholar 

  118. Steinberg J, Cheung V, Goel G, Pannell JS, Nation J, Khalessi A. Vessel-preserving stent-assisted coil embolization of an extracranial internal carotid artery pseudoaneurysm that developed after tonsillectomy in a pediatric patient: initial case report. J Neurosurg Pediatr. 2017;19(1):8–12.

    Article  PubMed  Google Scholar 

  119. Davidson AJ, Neff LP, Dubose JJ, Sampson JB, Abbot CM, Williams TK. Direct site endovascular repair (DSER): a novel approach to vascular trauma. J Trauma Acute Care Surg. 2016;81:S138–43.

    Article  PubMed  Google Scholar 

  120. Starnes BW, Arthurs ZM. Endovascular management of vascular trauma. Perspect Vasc Surg Endovasc Ther. 2006;18(2):114–29.

    Article  PubMed  Google Scholar 

  121. Arthurs ZM, Sohn VY, Starnes BW. Vascular trauma: endovascular management and techniques. Surg Clin North Am. 2007;87(5):1179–92, x–xi.

    Google Scholar 

  122. du Toit DF, Odendaal W, Lambrechts A, Warren BL. Surgical and endovascular management of penetrating innominate artery injuries. Eur J Vasc Endovasc Surg. 2008;36(1):56–62.

    Article  PubMed  Google Scholar 

  123. Bilos L, Pirouzram A, Toivola A, Vidlund M, Cha SO, Horer T. EndoVascular and Hybrid Trauma Management (EVTM) for Blunt innominate artery injury with ongoing extravasation. Cardiovasc Intervent Radiol. 2017;40(1):130–4.

    Article  PubMed  Google Scholar 

  124. Sobnach S, Nicol AJ, Nathire H, Edu S, Kahn D, Navsaria PH. An analysis of 50 surgically managed penetrating subclavian artery injuries. Eur J Vasc Endovasc Surg. 2010;39(2):155–9.

    Article  CAS  PubMed  Google Scholar 

  125. Johnson CA. Endovascular management of peripheral vascular trauma. Semin Intervent Radiol. 2010;27(1):38–43.

    Article  PubMed  PubMed Central  Google Scholar 

  126. Fox CJ, Gillespie DL, O’Donnell SD, Rasmussen TE, Goff JM, Johnson CA, et al. Contemporary management of wartime vascular trauma. J Vasc Surg. 2005;41(4):638–44.

    Article  PubMed  Google Scholar 

  127. Demetriades D, Velmahos GC, Scalea TM, Jurkovich GJ, Karmy-Jones R, Teixeira PG, et al. Operative repair or endovascular stent graft in blunt traumatic thoracic aortic injuries: results of an American Association for the Surgery of Trauma Multicenter Study. J Trauma. 2008;64(3):561–70; discussion 70–1.

    Google Scholar 

  128. Yamane BH, Tefera G, Hoch JR, Turnipseed WD, Acher CW. Blunt thoracic aortic injury: open or stent graft repair? Surgery. 2008;144(4):575–80; discussion 80–2.

    Google Scholar 

  129. Ott MC, Stewart TC, Lawlor DK, Gray DK, Forbes TL. Management of blunt thoracic aortic injuries: endovascular stents versus open repair. J Trauma. 2004;56(3):565–70.

    Article  PubMed  Google Scholar 

  130. Buz S, Zipfel B, Mulahasanovic S, Pasic M, Weng Y, Hetzer R. Conventional surgical repair and endovascular treatment of acute traumatic aortic rupture. Eur J Cardiothorac Surg. 2008;33(2):143–9.

    Article  PubMed  Google Scholar 

  131. Martin TD, Mattox KL, Feliciano DV. Prosthetic grafts in vascular trauma: a controversy. Compr Ther. 1985;11(2):41–5.

    CAS  PubMed  Google Scholar 

  132. Probe RA. Orthopaedic trauma mythbusters: is limb salvage the preferred method of treatment for the mangled lower extremity? Instr Course Lect. 2013;62:35–40.

    PubMed  Google Scholar 

  133. Akula M, Gella S, Shaw CJ, McShane P, Mohsen AM. A meta-analysis of amputation versus limb salvage in mangled lower limb injuries—the patient perspective. Injury. 2011;42(11):1194–7.

    Article  PubMed  Google Scholar 

  134. Helfet DL, Howey T, Sanders R, Johansen K. Limb salvage versus amputation. Preliminary results of the Mangled Extremity Severity Score. Clin Orthop Relat Res. 1990;256:80–6.

    Google Scholar 

  135. Kumar MK, Badole C, Patond K. Salvage versus amputation: utility of mangled extremity severity score in severely injured lower limbs. Indian J Orthop. 2007;41(3):183–7.

    Article  PubMed  PubMed Central  Google Scholar 

  136. Dagum AB, Best AK, Schemitsch EH, Mahoney JL, Mahomed MN, Blight KR. Salvage after severe lower-extremity trauma: are the outcomes worth the means? Plast Reconstr Surg. 1999;103(4):1212–20.

    Article  CAS  PubMed  Google Scholar 

  137. Behdad S, Rafiei MH, Taheri H, Behdad S, Mohammadzadeh M, Kiani G, et al. Evaluation of Mangled Extremity Severity Score (MESS) as a predictor of lower limb amputation in children with trauma. Eur J Pediatr Surg. 2012;22(6):465–9.

    Article  PubMed  Google Scholar 

  138. Lange RH, Bach AW, Hansen Jr ST, Johansen KH. Open tibial fractures with associated vascular injuries: prognosis for limb salvage. J Trauma. 1985;25(3):203–8.

    Article  CAS  PubMed  Google Scholar 

  139. Bosse MJ, McCarthy ML, Jones AL, Webb LX, Sims SH, Sanders RW, et al. The insensate foot following severe lower extremity trauma: an indication for amputation? J Bone Joint Surg Am. 2005;87(12):2601–8.

    PubMed  Google Scholar 

  140. Bosse MJ, EJ MK, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, et al. A prospective evaluation of the clinical utility of the lower-extremity injury-severity scores. J Bone Joint Surg Am. 2001;83-a(1):3–14.

    Article  CAS  PubMed  Google Scholar 

  141. Doukas WC, Hayda RA, Frisch HM, Andersen RC, Mazurek MT, Ficke JR, et al. The Military Extremity Trauma Amputation/Limb Salvage (METALS) study: outcomes of amputation versus limb salvage following major lower-extremity trauma. J Bone Joint Surg Am. 2013;95(2):138–45.

    Article  PubMed  Google Scholar 

  142. Yusuf SW, Baker DM, Wenham PW, Makin GS, Hopkinson BR. Role of Gritti-Stokes amputation in peripheral vascular disease. Ann R Coll Surg Engl. 1997;79(2):102–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  143. Wilson RH. Gunshots to the hand and upper extremity. Clin Orthop Relat Res. 2003;408:133–44.

    Article  Google Scholar 

  144. Bragaru M, Dekker R, Geertzen JH. Sport prostheses and prosthetic adaptations for the upper and lower limb amputees: an overview of peer reviewed literature. Prosthetics Orthot Int. 2012;36(3):290–6.

    Article  Google Scholar 

  145. Gonzalez-Fernandez M. Development of upper limb prostheses: current progress and areas for growth. Arch Phys Med Rehabil. 2014;95(6):1013–4.

    Article  PubMed  Google Scholar 

  146. Resnik L, Meucci MR, Lieberman-Klinger S, Fantini C, Kelty DL, Disla R, et al. Advanced upper limb prosthetic devices: implications for upper limb prosthetic rehabilitation. Arch Phys Med Rehabil. 2012;93(4):710–7.

    Article  PubMed  Google Scholar 

  147. Krueger CA, Rivera JC, Tennent DJ, Sheean AJ, Stinner DJ, Wenke JC. Late amputation may not reduce complications or improve mental health in combat-related, lower extremity limb salvage patients. Injury. 2015;46(8):1527–32.

    Article  PubMed  Google Scholar 

  148. Covey DC. Conversion from limb salvage to late amputation: lessons learned from recent battlefields with application to civilian trauma. J Surg Orthop Adv. 2015;24(3):170–3.

    Article  CAS  PubMed  Google Scholar 

  149. Melcer T, Sechriest VF, Walker J, Galarneau M. A comparison of health outcomes for combat amputee and limb salvage patients injured in Iraq and Afghanistan wars. J Trauma Acute Care Surg. 2013;75(2 Suppl 2):S247–54.

    Article  PubMed  Google Scholar 

  150. Hansen Jr ST. Overview of the severely traumatized lower limb. Reconstruction versus amputation. Clin Orthop Relat Res. 1989;243:17–9.

    Google Scholar 

  151. Warkentien T, Rodriguez C, Lloyd B, Wells J, Weintrob A, Dunne JR, et al. Invasive mold infections following combat-related injuries. Clin Infect Dis. 2012;55(11):1441–9.

    Article  PubMed  PubMed Central  Google Scholar 

  152. Warkentien TE, Shaikh F, Weintrob AC, Rodriguez CJ, Murray CK, Lloyd BA, et al. Impact of mucorales and other invasive molds on clinical outcomes of polymicrobial traumatic wound infections. J Clin Microbiol. 2015;53(7):2262–70.

    Article  PubMed  PubMed Central  Google Scholar 

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  1. Department of Surgery, American University of Beirut Medical Center, Makdissi Street, Beirut, 1107 2020, Lebanon

    Hasan Al Harakeh M.D. & Jamal J. Hoballah M.D., M.B.A., F.A.C.S.

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  1. Hasan Al Harakeh M.D.
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  2. Jamal J. Hoballah M.D., M.B.A., F.A.C.S.
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Correspondence to Jamal J. Hoballah M.D., M.B.A., F.A.C.S. .

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  1. Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon

    Ghassan Soleiman Abu-Sittah

  2. Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon

    Jamal J. Hoballah

  3. Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Centre-Faculty of Medicine, Beirut, Lebanon

    Joseph Bakhach

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Al Harakeh, H., Hoballah, J.J. (2017). Vascular Trauma. In: Abu-Sittah, G., Hoballah, J., Bakhach, J. (eds) Reconstructing the War Injured Patient. Springer, Cham. https://doi.org/10.1007/978-3-319-56887-4_15

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