Woodward E Baylor, Clouse W Darrin, Eliason Jonathan L, Peck Michael A, Bowser Andrew N, Cox Mitchell W, Jones W Tracey, Rasmussen Todd E
332nd EMDG/AFTH, Balad Air Base, Iraq.
J Vasc Surg. 2008 Jun;47(6):1259-64; discussion 1264-5. doi: 10.1016/j.jvs.2008.01.052. Epub 2008 Apr 14.
Wounding patterns, methods of repair, and outcomes from femoropopliteal injury have been documented in recent civilian literature. In Operation Iraqi Freedom, as in past conflicts, these injuries continue to be a therapeutic challenge. Therefore, the objective of the current study is to document the pattern of femoropopliteal injuries, methods of repair, and early outcomes during the current military campaign in Iraq.
From September 1, 2004, to April 30, 2007, all vascular injuries arriving at the Air Force Theater Hospital (the central echelon III medical facility in Iraq; equivalent to a civilian level I trauma center), Balad Air Base, Iraq were prospectively entered into a registry. From this, injuries involving the lower extremities were reviewed.
During the 32-month study period, 9289 battle-related casualties were assessed. Of these, 488 (5.3%) were diagnosed with 513 vascular injuries, and 142 casualties sustained 145 injuries in the femoropopliteal domain. Femoral level injury was present in 100, and popliteal level injury occurred in 45. Injuries consisted of 59 isolated arterial, 11 isolated venous, and 75 combined. Fifty-eight casualties were evacuated from forward locations. Temporary arterial shunts were placed in 43, of which 40 (93%) were patent on arrival at our facility. Our group used shunts for early reperfusion before orthopedic fixation, during mass casualty care, or autogenous vein harvest in 11 cases. Arterial repair was accomplished with autogenous vein in 118 (88%), primary means in nine (7%), or ligation in seven (5%). Venous injury was repaired in 62 (72%). Associated fracture was present in 55 (38%), and nerve injury was noted in 19 (13%). Early limb loss due to femoropopliteal penetrating injury occurred in 10 (6.9%). Early mortality was 3.5% (n = 5).
Femoropopliteal vascular injury remains a significant reality in modern warfare. Femoral injuries appear more prevalent than those in the popliteal region. Early results of in-theater repair are comparable with contemporary civilian reports and are improved from the Vietnam era. Rapid evacuation and damage control maneuvers such as temporary shunting and early fasciotomy assist timely definitive repair and appear effective.
近期的平民文献中已记录了股腘动脉损伤的伤口模式、修复方法及治疗结果。在伊拉克自由行动中，与以往冲突一样，这些损伤仍然是治疗上的一项挑战。因此，本研究的目的是记录伊拉克当前军事行动期间股腘动脉损伤的模式、修复方法及早期治疗结果。
从2004年9月1日至2007年4月30日，所有送达伊拉克巴拉德空军基地空军战区医院（伊拉克中央梯队三级医疗设施，相当于平民一级创伤中心）的血管损伤均被前瞻性地录入登记系统。据此，对涉及下肢的损伤进行回顾性分析。
在32个月的研究期间，共评估了9289例与战斗相关的伤员。其中，488例（5.3%）被诊断为513处血管损伤，142例伤员在股腘动脉区域有145处损伤。股动脉水平损伤100处，腘动脉水平损伤45处。损伤包括59处单纯动脉损伤、11处单纯静脉损伤和75处动静脉联合损伤。58例伤员从前线撤离。43例放置了临时动脉分流管，其中40例（93%）在到达我们的医疗机构时仍保持通畅。我们的团队在11例病例中使用分流管进行早期再灌注，这些病例包括在骨科固定前、大规模伤员救治期间或自体静脉采集时。118例（88%）动脉损伤采用自体静脉修复，9例（7%）采用一期修复，7例（5%）采用结扎。62例（72%）静脉损伤得到修复。55例（38%）伴有骨折，19例（13%）有神经损伤。因股腘动脉穿透伤导致的早期肢体缺失有10例（6.9%）。早期死亡率为3.5%（n = 5）。
股腘动脉血管损伤在现代战争中仍然是一个严峻的现实。股动脉损伤似乎比腘动脉区域的损伤更为普遍。战区内修复的早期结果与当代平民报告相当，且较越南战争时期有所改善。快速撤离以及诸如临时分流和早期筋膜切开术等损害控制措施有助于及时进行确定性修复，且似乎是有效的。
