Management of Vascular Trauma in Military Conflicts and Terrorist Attacks

In war and terror attacks, up to 12% of all casualties suffer a severe vascular injury. Therefore, management of vascular trauma is closely associated with lessons learned during the wars of the 20th and 21st century. This article discusses military aspects of vascular trauma based on historical developments and introduces current standards in military vascular surgery. Up to Word War II, ligation was the predominant therapy for severe vascular trauma. Beginning in the Korean and Vietnam Wars, arterial reconstruction became more and more feasible. This development - in conjunction with rapid helicopter evacuation - decreased the former amputation rate of almost 50% to less than 15%. Nevertheless, exsanguination still remains the major cause of death among casualties with potentially survivable injuries. Standard application of tourniquets, haemostyptica, and balloon occlusion of the aorta improved survival rate. Meanwhile, damage control principals are essential for Forward Surgical Teams and the use of temporary intravascular shunts is well implemented in combat settings. In many armed forces, sophisticated training programs ensure the necessary competence in vascular surgery for all military surgeons deployed. Military surgery provided ample evidence and experience in the management of major vascular trauma over the last century. Much of this knowledge has been translated to civilian health providers and ongoing developments in the military still influence the management of severe vascular trauma.