Gilat Efrat Keren, Khaitovitch Boris, Barash Yiftach, Tau Noam, Konen Eli, Halak Moshe, Silverberg Daniel, Raguan Barak, Sorin Vera, Raskin Daniel
Division of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel.
Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
PLoS One. 2025 Mar 18;20(3):e0319761. doi: 10.1371/journal.pone.0319761. eCollection 2025.
One of the feared complications of war-related peripheral vascular injury is the development of delayed hemorrhage. This study describes our experience with an innovative protocol of surveillance diagnostic angiography to detect occult late vascular complications in an effort to prevent delayed hemorrhage.
This retrospective cohort study was conducted at a single level one trauma center, reviewing patients with war-related peripheral vascular injuries caused by penetrating trauma from October 7th, 2023, to January 21st, 2024. Data collected included patient demographics, primary injury characteristics, associated complications, incidence of late vascular injuries (either symptomatic or occult), means of diagnosis, treatment strategies and outcomes.
The cohort included 41 patients with war-related peripheral vascular injuries affecting 51 limbs. All patients were male (100%) with a median age of 25 years, the majority being soldiers (85%). 24 occurrences of late vascular injuries were observed in 22 (43%) out of 51 limbs (100%). Half were symptomatic, with delayed hemorrhage occurring in 5 limbs in total (10%), and half were asymptomatic. A total of 17 surveillance diagnostic angiographies were performed with the sole indication of identifying occult late vascular injuries in asymptomatic patients, of which 4 (24%) were positive for findings. Five additional diagnostic angiographies were performed to assess late injuries discovered incidentally on imaging studies that were performed for other indications, and all were positive for late vascular injuries. Of all late vascular injuries, a total of 83% required subsequent treatment.
Late vascular injuries are a potentially lethal complication of war-related peripheral vascular injury. Aggressive surveillance with diagnostic angiography prior to discharge from a high intensity care unit can detect asymptomatic late vascular injuries, the treatment of which may prevent life-threatening hemorrhage.
与战争相关的周围血管损伤令人担忧的并发症之一是迟发性出血的发生。本研究描述了我们采用创新的监测诊断血管造影方案检测隐匿性晚期血管并发症以预防迟发性出血的经验。
本回顾性队列研究在一家一级创伤中心进行，回顾了2023年10月7日至2024年1月21日因穿透性创伤导致的与战争相关的周围血管损伤患者。收集的数据包括患者人口统计学资料、原发性损伤特征、相关并发症、晚期血管损伤（有症状或隐匿性）的发生率、诊断方法、治疗策略及结果。
该队列包括41例与战争相关的周围血管损伤患者，累及51条肢体。所有患者均为男性（100%），中位年龄25岁，大多数为士兵（85%）。在51条肢体中的22条（43%）观察到24例晚期血管损伤（100%）。其中一半有症状，共有5条肢体（10%）发生迟发性出血，另一半无症状。共进行了17次监测诊断血管造影，唯一目的是识别无症状患者的隐匿性晚期血管损伤，其中4例（24%）检查结果为阳性。另外进行了5次诊断血管造影，以评估在因其他指征进行的影像学检查中偶然发现的晚期损伤，所有检查结果均显示存在晚期血管损伤。在所有晚期血管损伤中，共有83%需要后续治疗。
晚期血管损伤是与战争相关的周围血管损伤的一种潜在致命并发症。在从重症监护病房出院前积极进行诊断性血管造影监测可检测出无症状的晚期血管损伤，对其进行治疗可预防危及生命的出血。
