Vascular Injury

SUMMARY OF CHANGES

- Contemporary epidemiology of combat vascular injuries, the impact of staged vascular care on limb salvage, and outcomes of cervical carotid injuries
- Preparation pearls for anastomosis and anastomotic techniques
- Endovascular inventory list has been updated to reflect items currently in use.
- Addition of materiel list for vascular exposure and revascularization

BACKGROUND

The treatment of vascular injuries in combat casualties can be a challenging endeavor, especially in resource constrained environments. Management of vascular trauma requires not only technical expertise on the part of the operating surgeon, but solid judgment on when to perform temporizing maneuvers versus definitive repairs. Surgeons at all Role 2 and 3 facilities need to be intimately familiar with the use of vascular shunts to stabilize a critically wounded casualty and then move them along the continuum of battlefield care. With the evolution of global conflict and risk for war with a peer enemy, a trauma system with rapid transport might not exist on a future battlefield; therefore, military surgeons at Role 2 facilities may not be able to evacuate casualties rapidly. There is also the potential for Role 3 facilities to not be readily available. Military surgeons must therefore be competent in the definitive surgical management of certain common life or limb-threatening vascular injuries. If definitive repair is required, surgeons must have the ability to ensure appropriate restoration of arterial inflow. If diagnostic capabilities are available (angiograms, plane film arteriograms), miliary surgeons need to have the skills to assess for restoration of appropriate flow. Appendix F lists the equipment required to have both a temporary vascular shunting capability and for definitive repair/reconstruction capability at any Role 2 or Role 3 facility.