Vascular Injury in the Wars in Iraq and Afghanistan

Abstract : Blood vessel trauma leading to hemorrhage or ischemia represents a significant cause of morbidity and mortality following injury. The objective of this study is to characterize the epidemiology of vascular injury in the wars in Iraq and Afghanistan and delineate anatomic patterns of injury, and the management categories of repair and ligation. Methods: The Joint Theater Trauma Registry was queried (2002-2009) for vascular injury in US troops and specific (Group 1) and operative (Group 2) groups defined. Group numbers were divided by battle related injuries (non-return to duty) to establish injury rates. Results: Group 1 included 1,570 Troops injured in Iraq (OIF) (n=1,390) and Afghanistan (OEF) (n=180). Mechanism included explosive (73%), gunshot (27%) and other (<1%) with explosive more common in OIF than OEF (p<0.05). During this period, 13,076 battle related injuries occurred resulting in a specific rate of 12% (1,570/13,076) which was higher in OIF than OEF (12.5% vs. 9% respectively; p<0.05). Of Group 1, 60% (n=940) sustained injury to major or proximal vessels and 40% (n=630) to minor or distal vessels (unknown vessel location, n=27). Group 2 comprised 1,212 Troops revealing an operative rate of 9% (1,212/13,076) which included ligation (n=660; 54%) or repair (n=552; 46%). Peak rates in OIF and OEF occurred in November 2004 (15%) and August 2009 (11%) respectively and correlated with combat operational tempo. Conclusion: The rate of vascular injury in modern combat is 5 times previously reported and varies according to theater of war, mechanism of injury and operational tempo. Methods of reconstruction are now applied to nearly half of wartime vascular injuries and should be the focus of training and combat support surgery. Ligation of vascular injury remains an important management strategy especially for minor or distal vascular injuries.