Epidemiology of Vascular Trauma

Despite an increasing understanding of global general trauma epidemiology, the same cannot be said for traumatic vascular injury. This is less well characterized, particularly in the civilian domain. The principal drivers of this hiatus are the absence of local or global datasets, poorly defined populations-at-risk, and a research focus 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%. This represents a fivefold increase from historical campaigns in South East Asia. Various mechanisms may account for this rise; but improvements in force protection, early battlefield resuscitation drills, and sophisticated medevac 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 addition, vascular injuries in the pediatric and geriatric cohorts pose population-specific challenges for vascular trauma specialists. Furthermore, the ever-evolving field of endovascular intervention is creating new patterns of iatrogenic vascular trauma. Consequently, the dynamic state of global society, as well as that of health care provision, necessitate radically different approaches to the management of traumatic vascular injury compared with those used in traditional trauma populations. The epidemiology of vascular injury thus reflects the broader societal challenges that humanity faces. Vascular and trauma surgeons should be aware of the heterogeneity of these injuries, as well of the risks associated with specific subpopulations susceptible to this type of trauma.