War dispatch: torn blood vessels growing problem
NEW YORK (Reuters Health) - U.S. troops appear to be sustaining more blood vessel tears now than in earlier wars, according to a new analysis of reports from the battlefield.
Of soldiers wounded in Iraq or Afghanistan, 12 percent had damaged blood vessels -- a number several times higher than reported earlier, from the Civil War though the Vietnam War.
"This has important implications for our troops," senior researcher Lt. Col. Dr. Todd Rasmussen of the U.S. Army Institute for Surgical Research in Fort Sam Houston, Texas, told Reuters Health.
"If (blood vessel) injury is this prevalent, then this information is important so that we can plan and train for its effective management."
But Rasmussen, who spent a year operating on this type of injury in the Middle East, also cautioned that there could be many reasons why more battlefield survivors are arriving at military hospitals with torn blood vessels.
During World War II, for instance, surviving the 10 to 15 hours it often took to reach medical care was no easy feat. That journey now takes under an hour.
Rasmussen and his team looked at data from the Joint Theater Trauma Registry, which contains information on combat injuries that might help improve prevention and care.
Studying 13,000 injuries occurring between 2002 and 2009, they found the rate of blood vessel damage varied with the intensity of war. It peaked at 15 percent in November 2004 in Iraq, and at 11 percent in August 2009 in Afghanistan.
Most of the time soldiers were wounded in their arms or legs, and often a major blood vessel was involved, according to the new report in the Annals of Surgery. About six percent of the soldiers died of their wounds.
The researchers also found that blasts accounted for about three times as many cases of blood vessel damage as did gunshots.
"The likelihood of a blood vessel getting hit is higher in an explosion compared to a gunshot," Rasmussen explained. "A blast can result in multiple penetrating wounds all over the body."
So could the increased use of explosives such as roadside bombs in modern warfare explain the rise in blood vessel injuries? Perhaps, but it is hard to be sure, said Rasmussen.
For instance, the shorter transport times to hospitals today mean more soldiers live to tell the tale, thus improving injury records. And greater use of tourniquets to stop bleeding, as well as modern body armor covering the vulnerable chest and belly, basically have the same effect, said Rasmussen.
Medical treatment also improved over time.
"In contrast to previous wars, we can intervene and repair up to half of the vascular injuries that we see," Rasmussen said, noting that only about 20 percent of vessels could be reconstructed during World War II.
He said the Army should prepare to handle the high number of torn blood vessels that come with modern combat.
"It is now imperative for us to act on these findings so we can continue to provide the best possible care for those in combat," Rasmussen added.
SOURCE: bit.ly/gSBff1 Annals of Surgery, online January 6, 2011.
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