Epidemiology of Vascular Injury

While the epidemiology of general trauma is increasingly well understood, the specific epidemiology of vascular injury is less well characterized, particularly in the civilian domain. Factors that mitigate against proper understanding of the rate and nature of vascular injury among populations include the absence of national, regional, or institutional datasets, poorly defined populations-at-risk, and concentration by researchers on specific injury subtypes at the expense of a general perspective. The prevalence of vascular injury in recent military engagements in Iraq and Afghanistan may be as high as 12%, a fivefold increase from previous campaigns in South East Asia. Various mechanisms may account for this rise; but improvements in force protection, early battlefield resuscitation drills, and medivac have almost certainly increased the number of patients reaching surgery alive, most of whom have extremity wounds. The prevalence of civilian vascular trauma is much lower but is subject to considerable regional variation. Torso injuries are more common than in military circumstances, but absence of large-scale registry data in most countries means that the burden of vascular trauma remains largely unknown. In many developed countries, a significant proportion of vascular injuries are iatrogenic in nature, contributing to vascular trauma that is increasing in prevalence as an older demographic is exposed to an ever-burgeoning suite of endovascular solutions to chronic diseases.