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 92nd Annual Clinical Congress, Chicago, IL, October 2006.

    LT COL
  • W. Darrin Clouse, MD, FACS

      Affiliations

    • 332nd 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.
    • Corresponding Author InformationCorrespondence 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.
    • , LT COL
  • Todd E. Rasmussen, MD, FACS

      Affiliations

    • 332nd 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.
    • , MAJ
  • Michael A. Peck, MD

      Affiliations

    • 332nd 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.
    • , MAJ
  • Jonathan L. Eliason, MD

      Affiliations

    • 332nd 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.
    • , MAJ
  • Mitchell W. Cox, MD

      Affiliations

    • 332nd 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.
    • , MAJ
  • Andrew N. Bowser, MD

      Affiliations

    • 332nd 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.
    • , COL
  • Donald H. Jenkins, MD, FACS

      Affiliations

    • 332nd 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.
    • , COL
  • David L. Smith, MD, FACS

      Affiliations

    • 332nd 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.
    • , COL (RET)
  • Norman M. Rich, MD, FACS

      Affiliations

    • Norman M Rich Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD.

Received 6 October 2006 ,Revised 8 January 2007 ,Accepted 17 January 2007.

References 

  1. DeBakey ME, Simeone FA. Battle injuries of the arteries in World War II. Ann Surg. 1946;123:534–579
  2. Hughes CW. The primary repair of wounds of major arteries: an analysis of experience in Korea in 1953. Ann Surg. 1955;141:297–303
  3. Hughes CW. Arterial repair during the Korean War. Ann Surg. 1958;147:555–561
  4. Jahnke EJ, Seeley SF. Acute vascular injuries in the Korean War. Ann Surg. 1953;138:158–177
  5. Jahnke EJ, Hughes CW, Howard JM. The rationale of arterial repair on the battlefield. Am J Surg. 1954;87:396–401
  6. Rich NM, Baugh JH, Hughes CW. Acute arterial injury in Vietnam: 1,000 cases. J Trauma. 1970;10:359–369
  7. Rich NM, Baugh JH, Hughes CW. Significance of complications associated with vascular repairs performed in Vietnam. Arch Surg. 1970;100:646–651
  8. Rich NM, Hughes CW. Vietnam vascular registry: a preliminary report. Surgery. 1969;65:218–226
  9. Fox CJ, Gillespie DL, O’Donnell SD, et al. Contemporary management of wartime vascular injury. J Vasc Surg. 2005;41:638–644
  10. Levels of medical care. In:  Lounsbury DE,  Bellamy RF, et al. editor. Emergency war surgery (Third United States revision). Washington, DC: Borden Institute; 2004;p. 2.1–2.10
  11. Starnes B, Beekley A, Sebesta J, et al. Extremity vascular injuries on the battlefield: tips for surgeons deploying to war. J Trauma. 2005;60:432–442
  12. Rasmussen TE, Clouse WD, Jenkins DH, et al. Echelons of care and the management of wartime vascular injury: a report from 332nd EMDG/Air Force Theater Hospital, Balad Air Base, Iraq. Perspect Vasc Surg Endovasc Ther. 2006;18:91–99
  13. Chambers LW, Rhee P, Baker BC, et al. Initial experience of US Marine Corps forward resuscitative surgical system during Operation Iraqi Freedom. Arch Surg. 2005;140:26–32
  14. Lakstein D, Blumenfeld A, Sokolov T, et al. Tourniquets for hemorrhage control on the battlefield: a 4-year accumulated experience. J Trauma. 2003;54(suppl):S221–S225
  15. Rasmussen TE, Clouse WD, Jenkins DH, et al. The use of temporary vascular shunts as a damage control adjunct in the management of wartime vascular injury. J Trauma. 2006;61:8–15
  16. Peck MA, Cox MW, Rasmussen TE, et al. The development and implementation of endovascular capabilities in wartime. Vascular. In press.
  17. Peck MA, Clouse WD, Cox MW, et al. The complete management of traumatic vascular injury in a local population during Operation Iraqi Freedom: a wartime report from the 332nd EMDG/Air Force Theater Hospital, Balad Air Base, Iraq. J Vasc Surg. In press.
  18. Sheffy N, Mintz Y, Rivkind A, et al. Terror-related injuries: a comparison of gunshot wounds versus secondary-fragments-induced injuries from explosives. J Am Coll Surg. 2006;203:297–303
  19. Lovric Z, Lehner V, Kosic-Lovric L, et al. Reconstruction of major arteries of lower extremities after war injuries (Long-term follow up). J Cardiovasc Surg. 1996;37:223–227
  20. Sfeir R, Khoury G, Kenaan M. Vascular trauma to the lower extremity: the Lebanese war experience. Cardiovasc Surg. 1995;3:653–657
  21. Sherif A. Vascular injuries: Experience during the Afghanistan War. Int Surg. 1992;77:114–117
  22. Nanobashvili J, Kopadze T, Tvaladze M, et al. War injuries of major extremity arteries. World J Surg. 2003;27:134–139
  23. Menakuru SR, Behera A, Jindal R, et al. Extremity vascular trauma in civilian population: a seven-year review from North India. Injury. 2005;36:400–406
  24. Thomas MO, Giwa SO, Adekoya-Cole TO. Arterial injuries in civilian practice in Lagos, Nigeria. Niger J Clin Pract. 2005;8:65–68
  25. Makitie I, Mattila VM, Pihlajamaki H. Severe vascular gunshot injuries of the extremities: a ten-year nation-wide analysis from Finland. Scand J Surg. 2006;95:49–54
  26. Asfar S, Al-Ali J, Safar H, et al. 155 vascular injuries: a retrospective study in Kuwait, 1992−2000. Eur J Surg. 2002;168:626–630
  27. Peoples G. Combat casualties in Afghanistan cared for by a single forward surgical team during the initial phases of Operation Enduring Freedom. Mil Med. 2005;170:462–468
  28. Rich NM, Rhee P. An historical tour of vascular injury management: from its inception to the new millennium. Surg Clin North Am. 2001;81:1199–1215
  29. Rich NM, Hughes CW, Baugh JH. Management of venous injuries. Ann Surg. 1970;171:724–730
  30. Rich NM. Management of venous trauma. Surg Clin North Am. 1988;68:809–821
  31. Rich NM. Principles and indications for primary venous repair. Surgery. 1982;91:492–496
  32. Rich NM, Collins CJ, Andersen CA, et al. Autogenous venous interposition grafts in repair of major venous injuries. J Trauma. 1977;17:512–520
  33. Timberlake GA, Kerstein MD. Venous injury: to repair or ligate, the dilemma revisited. Am Surg. 1995;61:139–145
  34. Ierardi RP, Kerstein MD. Venous injuries: military versus civilian experience. Mil Med. 1995;160:396–439
  35. Clouse WD, Rasmussen TE, Perlstein J, et al. Upper extremity vascular injury: a current in-theater wartime report from Operation Iraqi Freedom. Ann Vasc Surg. 2006;20:429–434

 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

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

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