McDonald Victoria S, Quail Jacob, Tingzon Marlon, Ayers Joseph D, Casey Kevin M
Naval Medical Center San Diego, San Diego, Calif.
Naval Medical Center San Diego, San Diego, Calif.
J Vasc Surg. 2016 Jun;63(6):1588-94. doi: 10.1016/j.jvs.2015.12.045. Epub 2016 Mar 4.
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.
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.
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).
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.
盆腔血管损伤（PVI）很少单独发生，常伴有严重的发病率。本研究的目的是调查战斗中发生的PVI的发生率、趋势和早期结局。
查询国防部创伤登记处，以确定在持久自由行动的前10年中所有接受PVI治疗的患者。检查患者的人口统计学资料、损伤机制、血管损伤类型、战区并发症和早期临床结局。
2003年至2012年期间，143例患者（99%为男性）在阿富汗发生了PVI。在此期间，患者就诊百分比持续上升（2003年为0.4%，2012年为2.0%）。平均损伤严重度评分（ISS）为24分。66%的患者损伤继发于爆炸。下车人员遇到的简易爆炸装置（IED）占所有损伤的47%，与所有其他损伤机制相比，其ISS显著更高（28分）（P <.01）。有85例（43%）动脉PVI和112例（57%）静脉PVI。最常见的动脉损伤是髂总动脉。股静脉损伤与更高的中位输血需求量相关。1例患者在战区死亡。与其他损伤机制相比，IED损伤的凝血病、酸中毒和体温过低发生率更高（P =.03）。42例患者（29%）发生早期感染并发症。与其他损伤机制相比，爆炸所致损伤的感染并发症发生率也显著更高（P <.01）。
在持久自由行动期间PVI的发生率不断增加。尽管死亡率一直较低，但并发症和感染率仍然很高，尤其是当损伤继发于爆炸时。IED与更高的ISS和并发症发生率相关。未来的研究必须继续关注战斗中发生的PVI的预防和治疗，特别是由爆炸引起的PVI。
