The epidemiology of XXXX in the wars in Iraq and Afghanistan.

@entity548 @entity63 @entity1317 @entity23806 @entity130
BACKGROUND: Blood vessel trauma leading to @entity548 or @entity63 presents a significant cause of morbidity and mortality after @entity130 . The objective of this study is to characterize the epidemiology of @entity1317 in the wars of Iraq and Afghanistan, including categorization of anatomic patterns, mechanism, and management of casualties. METHODS: The Joint Theater Trauma Registry was interrogated (2002-2009) for @entity1317 in US troops to identify specific injury (group 1) and operative intervention (group 2) groups. Battle-related @entity130 (nonreturn to duty) were used as the denominator to establish injury rates. @entity130 was compared between theaters of war and the management strategies of ligation versus revascularization (repair and interposition grafting) reported. RESULTS: Group 1 included 1570 Troops injured in Iraq ( @entity23806 ) (n = 1390) and Afghanistan (OEF) (n = 180). Mechanism included explosive (73%), gunshot (27%), and other (<1%) with explosive more common in @entity23806 than OEF (P < 0.05). During this period, 13,076 battle-related @entity130 occurred resulting in a specific rate of 12% (1570 of 13,076), which was higher in @entity23806 than OEF (12.5% vs 9% respectively; P < 0.05). Of group 1, 60% (n = 940) sustained injury to major or proximal vessels and 40% (n = 630) to minor or distal vessels (unknown vessel, n = 27). Group 2 (operative) comprised 1212 troops defining an operative rate of 9% (1212 of 13,076) and included ligation (n = 660; 54%) or repair (n = 552; 46%). Peak rates in @entity23806 and OEF occurred in November 2004 (15%) and August 2009 (11%), respectively and correlated with combat operational tempo. CONCLUSION: The rate of @entity1317 in modern combat is 5 times that reported in previous wars and varies according to theater of war, mechanism of injury and operational tempo. Methods of reconstruction are now applied to nearly half of the @entity1317 and should be a focus of training for combat surgery. Selective ligation of @entity1317 remains an important management strategy, especially for @entity130 .
