Editor's Choice - Preliminary Assessment of Contemporary Wartime Vascular Injuries

Vascular trauma during military conflicts, often from blasts and high velocity gunshots, is a major challenge in vascular surgery. Advances in vascular surgery have improved wartime injury management. This study evaluated vascular injury patterns and key risk factors for death and amputation in a recent conflict.

This retrospective study analysed vascular injuries in hospitalised soldiers from a recent conflict using National Trauma Registry data. Primary outcomes were major amputation and death. Descriptive statistics and logistic regression were used for data analysis, following the STrengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement.

From 7 October 2023 to 31 May 2024, a total of 2 040 Israeli soldiers (1 990 male, 97.5%; mean age 25 ± 6.9 years, median age [interquartile range, IQR] 23 [20, 28] years) were treated for injuries sustained in a recent military conflict. Among them, 179 cases (8.8%; 176 male, 98.3%; mean age 25 ± 7.19 years) were identified as vascular casualties. A total of 218 vascular injuries (in these 179 patients) were reported, with the lower extremities being the most affected region (112 of 218 vessels, 51.4%). The median time from injury to trauma centre arrival was 66 minutes and from the emergency department to surgery was 76 minutes (IQR 37, 330). In 136 patients, 161 vascular procedures were performed, mainly primary repair ± patch angioplasty (31.7%) and bypass (26.7%). Secondary amputation was required in 10 of 72 patients (13.9%) who underwent limb revascularization, with an overall mortality rate of 8.9% (n = 16 of 179). Multivariable analysis found high Injury Severity Scores (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.02 - 1.17; p = .016), systolic blood pressure < 90 mmHg on admission (OR 24.39, 95% CI 3.38 - 254.49; p = .003), and thoracic vessel injury (OR 15.23, 95% CI 1.68 - 177.04; p = .017) as risk factors for death. Lower extremity fractures (OR 6.51, 95% CI 1.35 - 49.01; p = .032) predicted lower extremity secondary amputation.

This study highlights the characteristics of vascular injuries in modern warfare, identifying higher mortality rates with thoracic vessel injuries, shock on admission, and high Injury Severity Scores, while secondary amputation correlated with lower extremity fractures.