Expeditionary Endovascular Trauma Care as a Core Capability for Future Large-Scale Conflicts.

Area of Science:

• Military Medicine
• Interventional Radiology
• Trauma Surgery

Background:

• Future conflicts present challenges with dispersed environments and uncertain evacuation, making uncontrolled hemorrhage a leading cause of preventable death.
• Civilian trauma care demonstrates endovascular techniques' efficacy in hemorrhage control and organ preservation, capabilities often lacking in forward military settings.

Purpose of the Study:

• To review the integration of interventional radiologists into forward surgical teams to enhance combat casualty survival and medical resilience.
• To examine historical military and civilian data, and modernization efforts to assess the feasibility and impact of expeditionary interventional radiology.

Main Methods:

• A narrative review of historical military experience, civilian trauma literature, and Department of Defense modernization efforts.
• Evidence was organized into five domains: historical evolution of imaging and intervention, civilian endovascular trauma outcomes, organ-specific endovascular repair, expeditionary integration models, and doctrinal requirements.

Main Results:

• Catheter-based hemorrhage control and endograft repair are feasible and lifesaving in deployed settings when imaging and expertise are co-located.
• Early embolization is highly effective for solid-organ and pelvic injuries, reducing transfusions and mortality; modern portable imaging makes it logistically achievable in austere environments.
• Doctrinal and personnel barriers, not technology, are the main obstacles to integrating interventional radiology in forward military facilities.

Conclusions:

• Deploying interventional radiologists with forward surgical teams enables immediate, on-site hemorrhage control, crucial for self-sufficient medical teams in future conflicts.
• These specialists provide procedural precision and leadership, extending critical care capabilities and reducing preventable deaths.
• Formal doctrinal inclusion of interventional radiologists in expeditionary surgical elements is essential for modern warfare survival and preserving fighting strength.