The Vascular Injury Legacy

For more than 2000 years, control of battlefield hemorrhage relied on compressive dressings. Added to this were the use of cautery, styptics, boiling oil, and a variety of other partially effective adjuncts. In Rome 2000 years ago, Galen advocated ligature of bleeding vessels. However, this was lost during the Dark Ages, and it was not until the 16th century that Ambroise Paré “reinvented” ligature of bleeding vessels when he ran out of boiling oil. Paré was also one of the first to devise instruments, including the bec de corbin to grasp bleeding vessels to assist with the ligature. At the turn of the 20th century, the development of clinical and experimental concepts related to vascular surgery progressed, and during the Korean War (1950-1953) successful repair of injured arteries and veins was accomplished consistently in the treatment of battlefield casualties. Over the past 50 years, additional advances in managing vascular trauma have been made in both civilian and military practices. These have included experiences with endovascular procedures, particularly over the past decade, transferring civilian experience to the management of battlefield casualties by coalition forces in Afghanistan and Iraq.