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A decade of pelvic vascular injuries during the Global War on Terror.
- Source :
-
Journal of vascular surgery [J Vasc Surg] 2016 Jun; Vol. 63 (6), pp. 1588-94. Date of Electronic Publication: 2016 Mar 04. - Publication Year :
- 2016
-
Abstract
- Background: Pelvic vascular injuries (PVIs) rarely occur in isolation and are often associated with significant morbidity. The purpose of this study was to examine the incidence, trends, and early outcomes of PVIs sustained in combat.<br />Methods: The Department of Defense Trauma Registry was queried to identify all patients treated with PVIs during the first 10 years of Operation Enduring Freedom. Patient demographics, mechanism of injury, type of vascular injury, in-theater complications, and early clinical outcomes were examined.<br />Results: From 2003 to 2012, 143 patients (99% male) sustained a PVI in Afghanistan. During this period, there was a persistent increase in the percentage of patient visits (0.4% in 2003 to 2.0% in 2012). The mean Injury Severity Score (ISS) was 24. Sixty-six percent of patient injuries were secondary to explosions. Improvised explosive devices (IEDs) encountered by dismounted personnel accounted for 47% of all injuries and were associated with a significantly higher ISS (28) compared with all other mechanisms of injury (P < .01). There were 85 (43%) arterial and 112 (57%) venous PVIs. The most frequent arterial injury was the common iliac artery. Injury to the femoral vein was associated with a higher median transfusion requirement. One patient died in combat theater. Injuries from IEDs had higher rates of coagulopathy, acidosis, and hypothermia compared with other mechanisms of injury (P = .03). Forty-two patients (29%) sustained early infectious complications. Injuries from explosions were also associated with a significantly higher rate of infectious complications compared with other mechanisms of injury (P < .01).<br />Conclusions: PVIs have occurred with increasing frequency during Operation Enduring Freedom. Despite a persistently low mortality, complication and infection rates remain high, particularly when injuries are secondary to explosions. IEDs are associated with higher ISS and complication rates. Future studies must continue to focus on the prevention and treatment of PVIs sustained in combat, particularly those caused by explosions.<br /> (Published by Elsevier Inc.)
- Subjects :
- Adult
Blast Injuries diagnosis
Blast Injuries mortality
Blast Injuries surgery
Female
Humans
Incidence
Injury Severity Score
Male
Registries
Retrospective Studies
Risk Factors
Surgical Wound Infection epidemiology
Time Factors
Treatment Outcome
United States
Vascular Surgical Procedures adverse effects
Vascular Surgical Procedures mortality
Vascular System Injuries diagnosis
Vascular System Injuries mortality
Vascular System Injuries surgery
War-Related Injuries diagnosis
War-Related Injuries mortality
War-Related Injuries surgery
Afghan Campaign 2001-
Blast Injuries epidemiology
Bombs
Military Medicine
Pelvis blood supply
Vascular System Injuries epidemiology
War-Related Injuries epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6809
- Volume :
- 63
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Journal of vascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 26951997
- Full Text :
- https://doi.org/10.1016/j.jvs.2015.12.045