2. Academic Validation
  3. Epidemiology of Upper Extremity Vascular Injury in Contemporary Combat

Epidemiology of Upper Extremity Vascular Injury in Contemporary Combat

  • Ann Vasc Surg. 2020 Jan;62:98-103. doi: 10.1016/j.avsg.2019.04.014.
Matthew Vuoncino 1,  Andrew J Soo Hoo 1,  Jigarkumar A Patel 1,  Paul W White 1,  Todd E Rasmussen 1,  Joseph M White 2
Affiliations

Affiliations

  • 1 Division of Vascular Surgery, The Department of Surgery at the Uniformed Services University of the Health Sciences & the Walter Reed National Military Medical Center, Bethesda, MD.
  • 2 Division of Vascular Surgery, The Department of Surgery at the Uniformed Services University of the Health Sciences & the Walter Reed National Military Medical Center, Bethesda, MD. Electronic address: [email protected].
PMID: 31344461 DOI: 10.1016/j.avsg.2019.04.014
Abstract

Background: The incidence of wartime upper-extremity vascular injury (UEVI) has been stable for the past century. The objective of this study is to provide a contemporary review of wartime UEVI, including epidemiologic characterization and description of early limb loss.

Methods: The Department of Defense Trauma Registry (DoDTR) was queried to identify US service members who sustained a battle-related UEVI in Afghanistan between January 2009 and December 2015. Anatomic distribution of injury, mechanism of injury (MOI), associated injuries, early management, and early limb loss were analyzed.

Results: Analysis identified 247 casualties who sustained 308 UEVIs. The most common injury was to the vessels distal to the brachial bifurcation (63.3%, n = 195), followed by the brachial vessels (27.3%, n = 84) and the axillary vessels (9.4%, n = 29). The predominant MOIs were penetrating explosive fragments (74.1%, n = 183) and gunshot wounds (25.9%, n = 64). Associated fractures were identified in 151 (61.1%) casualties and nerve injuries in 133 (53.8%). Angiography was performed in 91 (36.8%) casualties, and endovascular treatment was performed 10 (4%) times. Temporary vascular shunts were placed in 39 (15.8%) casualties. Data on surgical management were available for 171 injuries and included repair (48%, n = 82) and ligation (52%, n = 89). The early limb loss rate was 12.1% (n = 30). For all casualties sustaining early limb loss, the MOI was penetrating fragments from an explosion; the average injury severity score (ISS) was 32.3, and the mortality was 6.7% (n = 2). In those without amputation, the ISS and mortality were low at 20 and 4.6% (n = 10), respectively. Overall mortality was 4.9% (n = 12).

Conclusions: The early limb loss rate was increased compared with initial descriptions from Operation Iraqi Freedom. Amputations are associated with a higher ISS. Improved data capture and fidelity, or differing MOIs, may account for this trend. Proficiency with open and endovascular therapy remains a critical focus for combat casualty care.

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