Vascular Injuries

Advancement in the care of complex vascular injuries has largely been informed by the management of wartime injured over several centuries. The most rapid advances occurred between World War II and today and were propelled by several giants of vascular surgery including Drs. DeBakey, Rich, and Hughes. While improvement in prehospital and en route care has decreased mortality in modern conflict, they have also introduced new challenges in treating complex injuries requiring multidisciplinary care. Major vascular injury has historically been a relatively rare occurrence in civilian trauma. Unfortunately, with the spread of global terrorism and the wide availability of weaponry, both commercial and improvised, civilian surgeons need to be prepared to manage major vascular injuries. Blast injury and mass casualty incidents provide unique challenges due to mixed mechanisms of injury and the straining of resources. The following is a description of the epidemiology, diagnosis, and management of vascular injury as a result of blast/mass casualty incidents from point of injury to definitive care.