Frequency and structure of combat gunshot vascular injury in an advanced third-medical organization in a modern armed conflict

• Gavrilov E.K.
• Ramazanov A.Y.
• Goncharov A.V.
• Lyabah D.D.
• Khasanov A.R.

Abstract

Objective – to conduct a retrospective analysis of the frequency and structure of combat gunshot vascular injury in wounded people admitted to an advanced level 3 medical organization in the context of a modern armed conflict.

Material and methods. The medical histories of the wounded with combat gunshot vascular trauma who were admitted to a separate medical battalion deployed at the Central District Hospital of the Ministry of Health of the Russian Federation for 45 days (March–April 2023) were analyzed. In addition, the medical histories of the same wounded from the subsequent stage of medical evacuation were analyzed. All the wounded were men, whose average age was 30.7±4.8 years. The time elapsed from the moment of receiving a combat gunshot vascular injury to the moment of admission to the stage of providing specialized medical care averaged 2.20±1.24 hours. Statistical processing was carried out using Graphpad prism software.

Results and discussion. Combat gunshot vascular injuries were identified in 21 (7%) of 300 consecutively admitted wounded patients. In 15 (71%) of them, vascular injuries were combined, and in 6 (28%) – isolated. The most common injuries were to the vessels of the lower extremities – 9 (43%) victims. It is also necessary to note the diversity of clinical forms and types of combat gunshot vascular injury in different vascular areas. The most severe complications and deaths occurred in those wounded for whom 3 or more hours passed from the moment of injury to admission to the stage of specialized medical care. All wounded with combat gunshot vascular trauma underwent reconstructive vascular operations, which amounted to 17.4% of the total number of operations performed on 300 wounded. All operations were performed no more than 6 hours from the moment of injury. In the postoperative period, the following complications developed: hemorrhagic shock of III and IV degrees [3 (14%) and 1 (5%) wounded, respectively], acute respiratory failure [2 (9%) wounded], acute kidney injury [2 (9%) wounded], disseminated intravascular coagulation syndrome [2 (9%) wounded]. There were 2 (9%) deaths. At the next stage of evacuation, 3 (15%) wounded from this group underwent secondary amputation of the lower limb at the level of the middle third of the thigh.

Conclusion. Considering the high percentage of combat vascular trauma in the overall structure of injuries in a modern large-scale armed conflict, the strengthening of medical teams with narrow specialists (vascular surgeons) at the stage of an advanced medical organization of level 3 leads to a significant reduction in the number of limb amputations and mortality.

Funding. The study had no financial support.

Conflict of interest. The authors declare no conflicts of interest.

Authors’ contribution. Study conception and design – Gavrilov E.K.; data collection and handling – Ramazanov A.Y., Lyabah D.D.; statistical processing – Khasanov A.R.; draft manuscript preparation – Ramazanov A.Y.; manuscript revision – Gavrilov E.K., Goncharov A.V.

For citation: Gavrilov E.K., Ramazanov A.Y., Goncharov A.V., Lyabah D.D., Khasanov A.R. Frequency and structure of combat gunshot vascular injury in an advanced third-medical organization in a modern armed conflict. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (2): 143–50. DOI: https://doi.org/10.33029/1027-6661-2024-30-2-143-150

Keywords: combat gunshot vascular injury, CT angiography, ultrasound angioscanning, hemorrhagic shock, acute kidney injury, primary revascularization