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A decade of pelvic vascular injuries during the Global War on Terror
Victoria S McDonald1, Jacob Quail1, Marlon Tingzon1
1Naval Medical Center San Diego, San Diego, Calif.
Insights
Pelvic vascular injuries (PVIs) in combat are increasing, with explosions and improvised explosive devices (IEDs) causing severe trauma and high complication rates. Despite low mortality, preventing and treating these combat-related PVIs remains critical.
Area of Science:
- Trauma Surgery
- Vascular Surgery
- Military Medicine
Background:
- Pelvic vascular injuries (PVIs) are severe and rarely isolated.
- Combat environments present unique challenges for PVI management.
- Understanding PVI trends and outcomes in deployed settings is crucial.
Purpose of the Study:
- To analyze the incidence and trends of PVIs in combat.
- To examine early clinical outcomes and complications of combat-related PVIs.
- To identify injury mechanisms associated with worse outcomes.
Main Methods:
- Utilized the Department of Defense Trauma Registry.
- Included patients treated for PVIs during the first 10 years of Operation Enduring Freedom (2003-2012).
- Examined demographics, injury mechanisms, vascular injury types, complications, and outcomes.
Main Results:
- 143 patients sustained PVIs, with a rising incidence from 2003-2012.
- Explosions, particularly Improvised Explosive Devices (IEDs), were the primary cause (66%), associated with higher Injury Severity Scores (ISS).
- High rates of arterial (43%) and venous (57%) injuries were observed, with significant infectious complications (29%) and coagulopathy, acidosis, and hypothermia in IED-related injuries.
Conclusions:
- PVIs are increasingly frequent in Operation Enduring Freedom.
- Explosion-related injuries, especially from IEDs, lead to higher complication rates.
- Focus on prevention and treatment of combat PVIs, particularly those from explosions, is essential.
Background:
Pelvic vascular injuries (PVIs) rarely occur in isolation and are often associated with significant morbidity. The purpose of this study was to examine the incidence, trends, and early outcomes of PVIs sustained in combat.
Methods:
The Department of Defense Trauma Registry was queried to identify all patients treated with PVIs during the first 10 years of Operation Enduring Freedom. Patient demographics, mechanism of injury, type of vascular injury, in-theater complications, and early clinical outcomes were examined.
Results:
From 2003 to 2012, 143 patients (99% male) sustained a PVI in Afghanistan. During this period, there was a persistent increase in the percentage of patient visits (0.4% in 2003 to 2.0% in 2012). The mean Injury Severity Score (ISS) was 24. Sixty-six percent of patient injuries were secondary to explosions. Improvised explosive devices (IEDs) encountered by dismounted personnel accounted for 47% of all injuries and were associated with a significantly higher ISS (28) compared with all other mechanisms of injury (P < .01). There were 85 (43%) arterial and 112 (57%) venous PVIs. The most frequent arterial injury was the common iliac artery. Injury to the femoral vein was associated with a higher median transfusion requirement. One patient died in combat theater. Injuries from IEDs had higher rates of coagulopathy, acidosis, and hypothermia compared with other mechanisms of injury (P = .03). Forty-two patients (29%) sustained early infectious complications. Injuries from explosions were also associated with a significantly higher rate of infectious complications compared with other mechanisms of injury (P < .01).
Conclusions:
PVIs have occurred with increasing frequency during Operation Enduring Freedom. Despite a persistently low mortality, complication and infection rates remain high, particularly when injuries are secondary to explosions. IEDs are associated with higher ISS and complication rates. Future studies must continue to focus on the prevention and treatment of PVIs sustained in combat, particularly those caused by explosions.
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