Contemporary management of wartime vascular trauma
Contemporary management of wartime vascular trauma
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DOI：
10.1016/j.jvs.2005.01.010
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发表时间：
2005-04-01
影响因子：
4.3
通讯作者：
Rich, NM
中科院分区：
文献类型：
--
作者：
Fox, CJ;Gillespie, DL;Rich, NM
目的：战争创伤的治疗促进了血管创伤的诊断和治疗。最近的经验促使人们重新评估这类伤害的管理，特别是评估爆炸装置对伤害模式和治疗策略的影响。本报告的目的是提供在现代战时血管损伤护理损伤模式和管理策略的单一机构分析。方法：从2001年12月到2004年3月，在单一机构评估的所有战时撤离者被前瞻性地输入数据库并进行回顾性审查。收集的数据包括血管损伤的部位、类型和机制；相关的创伤;血管修复类型；最初的结果;神秘的损伤;截肢率;和并发症。自由应用动脉造影来评估这些损伤。审查了这种诊断和治疗方法的结果，特别是与爆炸受伤病人的护理有关的结果。结果：3057名后送医疗评价的士兵中，1524人（50%）有战斗损伤。107例（7%）患者发生已知或疑似血管损伤，这些患者组成了研究组。爆炸装置伤68例（64%），枪击伤27例（25%），钝性外伤12例（11%）。大多数损伤（59/66(88%)）发生在四肢。近一半（48/107）的患者在伊拉克或阿富汗的前沿医院接受了血管修复。28例（26%）在抵达美国时需要额外的手术干预。37%的士兵血管损伤与骨骨折有关。107人中有21人在撤离前进行了初级截肢手术。血管修复后截肢8例。其中，5人因伤口污染和移植物感染而四肢残缺。67例（63%）患者接受了诊断性血管造影。最常见的指征是损伤机制（42%），其次是异常检查（33%）、手术计划（18%）或修复评估（7%）。结论：这份中期报告是30多年来对美军血管损伤的最大规模分析。伤口模式反映了过去的经验，四肢受伤的比例很高。自体静脉移植修复动脉仍然是首选的治疗方法。应避免修复受污染的伤口床。在现代冲突中，简易爆炸装置造成的伤害有所增加，因此需要更广泛地应用动脉造影术。血管内技术在战时血管损伤的治疗中发挥了重要作用。
Objective: The treatment of wartime injuries has led to advances in the diagnosis and treatment of vascular trauma. Recent experience has stimulated a reappraisal of the management of such injuries, specifically assessing the effect of explosive devices on injury patterns and treatment strategies. The objective of this report is to provide a single-institution analysis of injury patterns and management strategies in the care of modern wartime vascular injuries.Methods: From December 2001 through March 2004, all wartime evacuees evaluated at a single institution were prospectively entered into a database and retrospectively reviewed. Data collected included site, type, and mechanism of vascular injury; associated trauma; type of vascular repair; initial outcome; occult injury; amputation rate; and complication. Liberal application of arteriography was used to assess these injuries. The results of that diagnostic and therapeutic approach, particularly as it related to the care of the blast-injured patient, are reviewed.Results: Of 3057 soldiers evacuated for medical evaluation, 1524 (50%) sustained battle injuries. Known or suspected vascular injuries occurred in 107 (7%) patients, and these patients comprised the study group. Sixty-eight (64%) patients were wounded by explosive devices, 27 (25%) were wounded by gunshots, and 12 (11%) experienced blunt traumatic injury. The majority of injuries (59/66 (88%)) occurred in the extremities. Nearly half (48/107) of the patients underwent vascular repair in a forward hospital in Iraq or Afghanistan. Twenty-eight (26%) required additional operative intervention on arrival in the United States. Vascular injuries were associated with bony fracture in 37% of soldiers. Twenty-one of the 107 had a primary amputation performed before evacuation. Amputation after vascular repair occurred in 8 patients. Of those, 5 had mangled extremities associated with contaminated wounds and infected grafts. Sixty-seven (63%) patients underwent diagnostic angiography. The most common indication was mechanism of injury (42%), followed by abnormal examination (33%), operative planning (18%), or evaluation of a repair (7%).Conclusions: This interim report represents the largest analysis of US military vascular injuries in more than 30 years. Wounding patterns reflect past experience with a high percentage of extremity injuries. Management of arterial repair with autologous vein graft remains the treatment of choice. Repairs in contaminated wound beds should be avoided. An increase in injuries from improvised explosive devices in modern conflict warrants the more liberal application of contrast arteriography. Endovascular techniques have advanced the contemporary management and proved valuable in the treatment of select wartime vascular injuries.