Development and implementation of endovascular capabilities in wartime

Background. Endovascular techniques are widespread in the management of civilian trauma and provide standard treatment for select injuries. Despite the commonality of this less invasive technology, there have been no reports on its use in wartime. The objective of this study was to describe the implementation of endovascular capability at a level III surgical facility in Iraq and illustrate the effectiveness of catheter-based techniques. Methods. From September 1, 2004 through April 30, 2007, injuries at the Air Force Theater Hospital, Balad, Iraq, were registered in a database and reviewed. Patients in whom endovascular procedures were performed comprise the study group (N = 139). Results. During this period, 150 catheter-based procedures were performed, including placement of 39 vena cava filters. The 111 nonfilter procedures were performed in the setting of extremity (N = 72), cervical (N = 19), and torso (N = 20) injuries. Of the diagnostic procedures, an abnormal finding was present in 67 (61%) cases, and 47 of these underwent either open surgical repair (N = 30) or endovascular treatment (N = 17). Endovascular therapies fell into three categories: embolization (N = 10), covered stent placement (N = 5), or miscellaneous (N = 2). The technical success rate of en-dovascular treatments was 100%, and procedure-related complications were uncommon (N = 4; 3%). Conclusion. This report is the first to demonstrate the effectiveness of diagnostic and therapeutic endovascular capability in the management of acute wartime injury. Implementation of this capability has unique requirements related to imaging and a trauma-specific endovascular inventory. Once established, however, endovascular capability markedly expands the injury management armamentarium and, in certain cases, provides the preferred treatment.