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Open Access Research article

Management of war-related vascular injuries: experience from the second gulf war

Ali Jawas1, Alaa K Abbas1, Munier Nazzal23, Marzoog Albader2 and Fikri M Abu-Zidan12*

Author Affiliations

1 Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, PO Box 17666, Al-Ain, United Arab Emirates

2 Department of Surgery, Mubarak Al-Kabeer Teaching Hospital, Jabriya, Kuwait

3 Division of Vascular and Endovascular Surgery, University of Toledo Medical Center, Toledo, Ohio, USA

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World Journal of Emergency Surgery 2013, 8:22  doi:10.1186/1749-7922-8-22

Published: 1 July 2013

Abstract

Aim

To study the biomechanism, pattern of injury, management, and outcome of major vascular injuries treated at Mubarak Al-Kabeer Teaching Hospital, Kuwait during the Second Gulf War.

Methods

This is a descriptive retrospective study. War-related injured patients who had major vascular injuries and were treated at Mubarak Al-Kabeer Teaching Hospital from August 1990 to September 1991 were studied. Studied variables included age, gender, anatomical site of vascular injury, mechanism of injury, associated injuries, type of vascular repair, and clinical outcome.

Results

36 patients having a mean (SD) age of 29.8 (10.2) years were studied. 32 (89%) were males and 21 (58%) were civilians. Majority of injuries were caused by bullets (47.2%) and blast injuries (47.2%). Eight patients (22%) presented with shock.

There were 31 arterial injuries, common and superficial femoral artery injuries were most common (10/31). Arterial repair included interposition saphenous vein graft in seven patients, thrombectomy with end-to-end / lateral repair in twelve patients, vein patch in two patients, and arterial ligation in four patients. Six patients had arterial ligation as part of primary amputation. 3/21 (14.3%) patients had secondary amputation after attempted arterial vascular repair of an extremity. There were a total of 17 venous injuries, 13 managed by lateral suture repair and 4 by ligation. The median (range) hospital stay was 8 (1–76) days. 5 patients died (14%).

Conclusions

Major vascular injuries occurred in 10% of hospitalized war-related injured patients. Our secondary amputation rate of extremities was 14%. The presence of a vascular surgeon within a military surgical team is highly recommended. Basic principles and techniques of vascular repair remain an essential part of training general surgeons because it may be needed in unexpected wars.

Keywords:
Injury; Management; Trauma; Vascular; War