Emergency War Surgery NATO Handbook: Part III: General Considerations of Wound Management: Chapter XVIII: Vascular Injuries

Introduction

United States Department of Defense

In recent wars, vascular injuries of the extremities have only comprised about 1-2% of all major injuries seen in living casualties. However, major vascular injuries are always life threatening and may result in significant morbidity among survivors. Advances in peripheral vascular surgery over the last thirty years have made it possible to repair major arterial and venous injuries not only in the civilian trauma setting but also in the combat zone hospital. Dramatic results following vascular repair can be expected if proper surgical facilities and experienced personnel are available On the other hand, the performance of major vascular operations requires a significant commitment of time and resources. When surgical facilities are inadequate or overrun by large numbers of casualties, the performance of major vascular procedures is inappropriate. Under such unfortunate conditions, amputation rather than vascular repair may be more appropriate. Under these circumstances, experience and mature judgement are required to make the proper decision for each patient.

Table 10. - Arterial wounds and associated injuries, Vietnam, 1965-1970

Major vascular injuries almost always require prompt surgical intervention if the tissues supplied are to be salvaged. Diagnosis and preliminary management should begin in the field, and these patients should be evacuated promptly to a definitive treatment facility. Operational conditions may have a profound influence on the ultimate outcome of vascular injuries. During the Vietnam conflict, for instance, helicopter evacuation allowed many who might have otherwise expired to reach the hospital alive. Whether or not similar circumstances will exist in future conflicts remains to be seen.

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Operational Medicine 2001

Health Care in Military Settings

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