Temporary arterial shunts in combat patient with vascular injuries to extremities wounded in Russian-Ukrainian war: A case report.

INTRODUCTION AND IMPORTANCE: Vascular injuries to extremities are common in armed conflicts. Such kind of injury is associated with a high risk of critical ischemia, limb amputation, and high morbidity. There is a clinical challenge for the management of vascular injuries to extremities in ongoing warfare due to limited medical resources. PRESENTATION OF CASE: A 34 years old male received a gunshot injury to both low extremities on March, 23rd 2022 in a battlefield area 30 km away from Kyiv city. CAT tourniquet was applied to stop the bleeding and the patient was transported to Level II by ambulance 40 min after the injury. The patient was diagnosed with a gunshot injury to the left superficial femoral artery (SFA) followed by primary surgical debridement and temporary arterial shunting at Level II hospital. Then the patient was evacuated to Level IV hospital, diagnosed with an injury to the right popliteal artery, and underwent vascular reconstruction. CLINICAL DISCUSSION: Arterial shunting is a well-known approach to prevent critical ischemia and limb amputations of injured extremities in both combat and civilian patients. This case report provides evidence for the utility of temporary arterial shunting in combat conditions, which is supported by data from the larger cohorts. We consider temporary vascular shunting as a damage control measure to be associated with high chances of limb salvage in ongoing warfare. CONCLUSION: Our study demonstrated the utility of temporary arterial shunting in combat patients with gunshot wounds in ongoing warfare, which could be performed even in case of limited medical resources.

A Case of Surgical Treatment of a Gunshot Wound to the Left Scapular Region With Damage to the Distal Axillary and Proximal Brachial Arteries.

INTRODUCTION: The incidence of vascular damage in modern combat conflicts is 5 times higher than in previous military conflicts, with one in five wounded having uncontrolled severe blood loss. Treatment of gunshot wounds of the main arteries is a complex multi-level process, which can be done only in the case of close cooperation of related surgical specialties. CASE REPORT: This case report details treatment of a 40-year-old man who was admitted with a gunshot wound to the left shoulder with injury of the distal axillary and proximal brachial arteries. Primary surgical treatment consisted of venous interposition graft of the injured artery and debridement of the scapular wounds in a peripheral hospital. He was transferred to Main Military Medical Clinical Center in Kyiv with acute thrombosis of the vascular repair graft. Urgent reoperation was performed, with removal of the previously placed vascular graft and revascularization of the distal axillary and proximal brachial artery with reverse venous graft, with accompanying fasciotomy. CONCLUSION: This case demonstrates the crucial role of rapid evacuation of wounded to a specialized level of care for complex cases such as arterial reconstruction.