Vascular Injuries in an Urban Combat Setting: Experience from the 2006 Lebanon War

Abstract

Vascular injuries are manifested by life-threatening hemorrhage or limb loss and their diagnosis and treatment are challenging. Angiography is beyond the capability of available teams during wartime. Thus, computed tomographic angiography (CTA) may become a major triage tool. This study reports on the presentation, diagnosis, management and outcome of combat vascular injuries with emphasis on the utility of CTA. Presenting signs and symptoms, means of diagnosis, treatments and results of all combat sustained vascular cases were collected and compiled with follow-up. Of 511 patients, 39 patients (7.6%) with vascular injuries were admitted. Injuries were penetrating and accompanied by soft tissue and bone insult. Diagnosis was made by CTA in 62% and by surgical exploration in 38%. Extremity arteries were injured in 72% of cases. Treatment included surgical and endovascular techniques. Complications: one late amputation, 5% thrombosis, 24% wound infections with no mortalities or early amputations. Although similarities exist between this experience and recent wartime reports, differences are apparent including the effectiveness of CTA. High index of suspicion and liberal use of CTA allows for an early and accurate diagnosis of a vascular injury resulting in high rates of limb salvage and low mortality. CTA should be the first line modality for diagnosis of vascular injuries, reserving angiography for endovascular treatment.