Experience in the use of open, endovascular, and hybrid methods of treating combat injuries of blood vessels: observations of one surgeon
- Authors: Reva V.A1
-
Affiliations:
- The S.M.Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation
- Issue: Vol 342, No 9 (2021)
- Pages: 57-68
- Section: Articles
- URL: https://journals.eco-vector.com/0026-9050/article/view/82668
- DOI: https://doi.org/10.52424/00269050_2021_342_9_57
- ID: 82668
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Open Access
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Abstract
Delivering medical care for the wounded with combat injuries of blood vessels is one of the most difficult problems of military field surgery due to the high frequency of deaths and amputations of the extremities. The author’s personal experience of providing assistance to 20 wounded with vascular injuries in modern military conflicts at different levels of surgical care is described. An increase in the number of vascular injuries in military conflicts has been shown up to 10%. Moreover, 80% of them are wounds of the main vessels of the extremities (2/3 - the lower extremities, 1/3 - the upper). Only 15% of the wounded had intracavitary bleeding, 2 were delivered to the stage of surgical care in a terminal state. For the stabilization of hemodynamics in the latter, for the first time in the combat zone, the method of resuscitation endovascular balloon occlusion of the aorta was used. The widespread use of ultrasound diagnostics, diagnostic angiography through the installation of an introducer, early operations depending on the condition of the wounded and the degree of limb ischemia (autovenous plasty, lateral suture, temporary vascular prosthetics, recanalization, and arterial endoprosthetics, wide fasciotomy) made it possible to exclude cases of death and secondary amputations of the extremities.
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About the authors
V. A Reva
The S.M.Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation
Email: vreva@mail.ru
St. Petersburg, Russia
References
- Белевитин А.Б., Самохвалов И.М., Фомин Н.Ф. и др. Проблема временной остановки наружного кровотечения при ранениях магистральных сосудов конечностей от Н.И.Пирогова до наших дней // Вестн. Рос. воен.-мед. акад. - 2010. - Спец. вып. - С. 13-18.
- Крайнюков П.Е., Самохвалов И.М., Рева В.А. Тактическая медицина - новая концепция для войн «нового типа» // Воен.-мед. журн. - 2021. - Т. 342, № 5. - С. 4-17.
- Рева В.А., Петров А.Н., Самохвалов И.М. Первый отечественный опыт применения эндоваскулярной баллонной окклюзии аорты в зоне боевых действий // Ангиол. и сосуд. хир. - 2021. - Т. 27, № 2. - С. 61-75.
- Рева В.А., Самохвалов И.М. Эндоваскулярная хирургия на войне // Ангиол. и сосуд. хир. - 2015. - Т. 21, № 2. - С. 166-175.
- Самохвалов И.М. Боевые повреждения магистральных сосудов: диагностика и лечение на этапах медицинской эвакуации: Дис.. д-ра мед. наук. - СПб, 1994. - 390 с.
- Самохвалов И.М., Бадалов В.И., Рева В.А., Головко К.П., Петров А.Н. и др. Перспективные технологии оказания хирургической помощи раненым // Воен.-мед. журн. - 2013. - Т. 334, № 6. - С. 24-30.
- Самохвалов И.М., Рева В.А., Фомин Н.Ф., Гончаров А.В., Фисун А.Я. Принцип эшелонирования в подготовке военно-полевых хирургов и его практическая реализация // Воен.-мед. журн. - 2020. - Т. 341, № 8. - С. 4-24.
- Светликов А.В., Рева В.А., Игнатенко М.В. Применение эндоваскулярной баллонной окклюзии аорты у гемодинамически нестабильных пациентов при кровотечениях (обзор вебинара) // Ангиол. и сосуд. хир. - 2021. - Т. 27, № 1. - С. 72-74.
- Фисун А.Я., Самохвалов И.М., Гончаров А.В., Рева В.А., Каниболоцкий М.Н. и др. Пути снижения летальности в современной гибридной войне: раненого к хирургу или хирургию к раненому? // Воен.-мед. журн. - 2020. - Т. 341, № 1. - С. 20-29.
- DuBose J.J., Rajani R., Gilani R. et al. Endovascular management of axillo-subclavian arterial injury: a review of published experience // Injury. - 2012. - Vol. 43, N 11. - P. 1785-1792.
- Faulconer E.R., Branco B.C., Loja M.N. et al. Use of open and endovascular surgical techniques to manage vascular injuries in the trauma setting: A review of the American Association for the Surgery of Trauma PROspective Observational Vascular Injury Trial registry // J. Trauma Acute Care Surg. - 2018. - Vol. 84, N 3. - P. 411-417.
- Montorfano M.A., Montorfano L.M., Perez Quirante F. et al. The FAST D protocol: a simple method to rule out traumatic vascular injuries of the lower extremities // Crit. Ultrasound J. - 2017. - Vol. 9, N 1. - P. 1-8.
- Patel J.A., White J.M., White P.W. et al. A contemporary, 7-year analysis of vascular injury from the war in Afghanistan // J. Vasc. Surg. - 2018. - Vol. 68, N 6. - P. 1872-1879.
- Rasmussen T.E., Baer D.G., Doll B.A., Caravalho Jr.J. In the «Golden Hour» // Army AL&T Magazine. - 2015. - Vol. Jan-Mar. - P. 80-85.
- Rasmussen T.E., Stockinger Z., Antevil J. et al. Vascular Injury (CPG ID: 46) / In: 2018 Joint Trauma System Clinical Practice Guideline. - 2018. - P. 1-34.
- Rasmussen T.E., Woodson J., Rich N.M., Mattox K.L. Vascular trauma at a crossroads // J. Trauma. - 2011. - Vol. 70, N 5. - P. 1291-1293.
- Reva V.A., Morrison J.J., Samokhvalov I.M. Successful fluoroscopy-free extremity endovascular revascularisation in an austere environment // J. Endovasc. Resusc. Trauma Management. - 2019. - Vol. 3, N 3. - P. 133-138.
- Rohlffs F., Larena-Avellaneda A.A., Petersen J.P. et al. Through-and-through wire technique for endovascular damage control in traumatic proximal axillary artery transection // Vascular. - 2015. - Vol. 23, N 1. - P. 99-101.
- Scalea T.M., Sclafani S.J. Angiographically placed balloons for arterial control: a description of a technique // J. Trauma. - 1991. - Vol. 31, N 12. - P. 1671-1677.
Supplementary files
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).