In-Theater Management of Vascular Injury: 2 Years of the Balad Vascular Registry

Clouse, W. Darrin; Rasmussen, Todd E.; Peck, Michael A.; Eliason, Jonathan L.; Cox, Mitchell W.; Bowser, Andrew N.; Jenkins, Donald H.; Smith, David L.; Rich, Norman M.

doi:10.1016/j.jamcollsurg.2007.01.040

« Previous Next »Journal of the American College of Surgeons
Volume 204, Issue 4 , Pages 625-632, April 2007

In-Theater Management of Vascular Injury: 2 Years of the Balad Vascular Registry

Presented at the American College of Surgeons 92^nd Annual Clinical Congress, Chicago, IL, October 2006.

W. Darrin Clouse, MD, FACS
- 332^nd Expeditionary Medical Group, Air Force Theater Hospital, Balad Air Base, Iraq
- Wilford Hall US Air Force Medical Center, Lackland Air Force Base, TX
- Norman M Rich Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD.
- Correspondence address: Lt Col W Darrin Clouse, MD, FACS, Division of Vascular and Endovascular Surgery, Wilford Hall US Air Force Medical Center, 2200 Bergquist Dr, Ste 1, Lackland AFB, TX 78236-5200.
Todd E. Rasmussen, MD, FACS
- 332^nd Expeditionary Medical Group, Air Force Theater Hospital, Balad Air Base, Iraq
- Wilford Hall US Air Force Medical Center, Lackland Air Force Base, TX
- Norman M Rich Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD.
Michael A. Peck, MD
- 332^nd Expeditionary Medical Group, Air Force Theater Hospital, Balad Air Base, Iraq
- Wilford Hall US Air Force Medical Center, Lackland Air Force Base, TX
- Norman M Rich Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD.
Jonathan L. Eliason, MD
- 332^nd Expeditionary Medical Group, Air Force Theater Hospital, Balad Air Base, Iraq
- Wilford Hall US Air Force Medical Center, Lackland Air Force Base, TX
- Norman M Rich Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD.
Mitchell W. Cox, MD
- 332^nd Expeditionary Medical Group, Air Force Theater Hospital, Balad Air Base, Iraq
- Wilford Hall US Air Force Medical Center, Lackland Air Force Base, TX
- Norman M Rich Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD.
Andrew N. Bowser, MD
- 332^nd Expeditionary Medical Group, Air Force Theater Hospital, Balad Air Base, Iraq
- Wilford Hall US Air Force Medical Center, Lackland Air Force Base, TX
- Norman M Rich Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD.
Donald H. Jenkins, MD, FACS
- 332^nd Expeditionary Medical Group, Air Force Theater Hospital, Balad Air Base, Iraq
- Wilford Hall US Air Force Medical Center, Lackland Air Force Base, TX
- Norman M Rich Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD.
David L. Smith, MD, FACS
- 332^nd Expeditionary Medical Group, Air Force Theater Hospital, Balad Air Base, Iraq
- Wilford Hall US Air Force Medical Center, Lackland Air Force Base, TX
- Norman M Rich Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD.
Norman M. Rich, MD, FACS
- Norman M Rich Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD.

Received 6 October 2006; received in revised form 8 January 2007; accepted 17 January 2007.

Background

Wartime vascular injury management has traditionally advanced vascular surgery. Despite past military experience, and recent civilian publications, there are no reports detailing current in-theater treatment. The objective of this analysis is to describe the management of vascular injury at the central echelon III surgical facility in Iraq, and to place this experience in perspective with past conflicts.

Study Design

Vascular injuries evaluated at our facility between September 1, 2004 and August 31, 2006 were prospectively entered into a registry and reviewed.

Results

During this 24-month period, 6,801 battle-related casualties were assessed. Three hundred twenty-four (4.8%) were diagnosed with 347 vascular injuries. Extremity injuries accounted for 260 (74.9%). Vascular injuries in the neck (n = 56; 16.1%) and thoracoabdominal domain (n = 31; 8.9%) were less common. US forces accounted for 149 casualties (46%), 97 (30%) were local civilian, and 78 (24%) were Iraqi forces. One hundred seven (33%) patients with vascular injury were evacuated from forward locations after treatment initiation. Fifty-four (50%) of these had temporary shunts placed. Of 43 proximal shunts placed in-field, 37 (86%) were patent at the time of our assessment. Early amputation rate was 6.6% for those extremity injuries treated for limb salvage. Perioperative mortality was 4.3%.

Conclusions

This evaluation represents the first in-theater report of wartime vascular injury since Vietnam. Extremity injuries continue to predominate, although the incidence of vascular injury appears to be somewhat increased. Local forces and civilians now represent a substantial proportion of those injured. The principles of rapid evacuation, temporary shunting, and early reconstruction are effective, with satisfactory early in-theater limb salvage.

Abbreviations and Acronyms: AFTH, Air Force Theater Hospitals, EMDG, Expeditionary Medical Group, LE, lower extremity, OIF, Operation Iraqi Freedom, UE, upper extremity

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Competing Interests Declared: None.

This article represents the personal viewpoints of the authors and cannot be construed as a statement of Department of Defense or US Government policy.

PII: S1072-7515(07)00131-7

doi:10.1016/j.jamcollsurg.2007.01.040

« Previous Next »Journal of the American College of Surgeons
Volume 204, Issue 4 , Pages 625-632, April 2007

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