29 - Europe: Russia

Abstract

We present our experience in treating patients with vascular injuries during the Soviet War in Afghanistan (1979-1989) and during the conflicts in the North Caucasus of Russia (1994-1996; 1999-2002). The rate of vascular injuries among all injured combatants in Afghanistan amounted to 4.5%, and in the North Caucasus they amounted to 6%. Surgical approaches to injured arteries of the extremities were based on the type of acute ischemia. In the setting of compensated ischemia, there are no indications for urgent vascular reconstruction, as safe ligation of the artery is possible. Uncompensated ischemia requires the urgent restoration of blood flow, or the extremity will undergo necrosis in 6 to 8 hours. In irreversible ischemia, amputation is justified; because arterial reconstruction under field conditions after this length of time without perfusion may lead to the death from endotoxemia. In both conflicts, military surgeons in medical units near the point of injury carried out damage control surgical tactics, such as temporary shunting of the injured arteries. Next, patients were evacuated and underwent definitive vascular reconstruction by vascular surgeons at larger frontline military hospitals. The rate of temporary shunting in primary vascular surgical operations amounted to 17.1% in Afghanistan and 25% and 16% in the first and second conflicts in the North Caucasus, respectively. Among patients treated for vascular injuries in Afghanistan, satisfactory outcomes were achieved in 43% (33% of all patients with vascular injuries returned to duty), 45% were dismissed, and the mortality rate was 12%. In the North Caucasus, 57% of patients returned to duty, while the mortality rate was 9.4% in the first conflict and 7.6% in the second.