Search

In North America and Australia, systems of trauma care have been shown to reduce mortality and morbidity in injured patient populations. These systems rely on a health infrastructure that can rapidly match the patient's needs to the appropriate level of care, is able to ensure expeditious transport to the right health facility, and can ensure that treatment is rendered seamlessly across the whole of the patient's pathway. To function properly and to assure progressive improvement in standards, trauma systems are dependent on continuous analysis of outcome and process data allied to feedback mechanisms whose improvement actions are underwritten by an agreed authority. Proven in civilian circumstances, this concept was deployed in Afghanistan and Iraq to remarkable effect. The “ownership” of the vascular-injured trauma patient, whether treated within an overarching system of care or not, varies according to national and local circumstances. Vascular-trained surgeons have a stake in making sure that the same principles that increasingly govern their systems of care for patients with degenerative and chronic vascular disease are applied to patients with vascular injury. Trauma-trained surgeons have responsibilities to ensure that the domain knowledge and endovascular expertise of the vascular surgical community is continuously leveraged. By developing this dialogue, surgeons can safeguard the progressive systemization of care for patients with vascular injury and can set the conditions for continued improvement in outcome.

While the epidemiology of general trauma is increasingly well understood, the specific epidemiology of vascular injury is less well characterized, particularly in the civilian domain. Factors that mitigate against proper understanding of the rate and nature of vascular injury among populations include the absence of national, regional, or institutional datasets, poorly defined populations-at-risk, and concentration by researchers 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%, a fivefold increase from previous campaigns in South East Asia. Various mechanisms may account for this rise; but improvements in force protection, early battlefield resuscitation drills, and medivac 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 many developed countries, a significant proportion of vascular injuries are iatrogenic in nature, contributing to vascular trauma that is increasing in prevalence as an older demographic is exposed to an ever-burgeoning suite of endovascular solutions to chronic diseases.