A single-center experience in the management of combat-related extremity vascular injuries

Objective: Combat-related vascular injuries account for up to 12% of trauma cases, with peripheral vessel injuries being the most prevalent among casualties. The ongoing military conflict in the Middle East has led to the widespread use of explosive devices and missiles, resulting in a high incidence of peripheral vascular trauma. Methods: This study presents a retrospective single-center analysis of all patients with peripheral vascular trauma admitted to our facility between October 2023 and November 2024. Data on patient demographics, injury patterns, surgical interventions, and outcomes were collected and analyzed. Results: Among 896 admitted patients, 41 (4.6%) sustained 43 vascular injuries. Peripheral vessel injuries accounted for 88.3% of all cases. The mean age was 23 years and the median Injury Severity Score was 18. Lower limb involvement was observed in 84.2%, and upper limb injuries comprised 15.7%. The femoral and popliteal arteries were the most frequently injured. The 30-day primary patency rate for vascular repairs was 87.1%, with a secondary patency rate of 93.5%. Four cases of graft occlusion and five major amputations were recorded. One late false aneurysm formation was detected and successfully repaired. After a median follow-up of 11 months, the overall patency rate of vascular repairs was 90%. Conclusions: Despite the devastating blast mechanisms underlying most injuries, current treatment strategies have resulted in a relatively low amputation rate. As expected, lower extremity vascular injuries were most prevalent, often requiring interposition or bypass grafting for reconstruction. Decision-making regarding the salvageability of mangled extremities should be multidisciplinary, prioritizing patient status and assessing the feasibility of vascular and skeletal repair before determining the definitive course of action.