{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T19:22:44Z","timestamp":1780946564345,"version":"3.54.1"},"reference-count":49,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2020,12,23]],"date-time":"2020-12-23T00:00:00Z","timestamp":1608681600000},"content-version":"unspecified","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007217","name":"Health Services Research and Development","doi-asserted-by":"publisher","award":["HX001304\/IIR 13-029"],"award-info":[{"award-number":["HX001304\/IIR 13-029"]}],"id":[{"id":"10.13039\/100007217","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2020,12,5]]},"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Extremity vascular injury (EVI) causes significant disability in Veterans of the Afghanistan\/Iraq conflicts. Advancements in acute trauma care improved survival and decreased amputations. The study of wartime EVI has relied on successful limb salvage as a surrogate for vascular repair. We used imaging studies as a specific measure of arterial repair durability.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Service members with EVI were identified using the Department of Defense Trauma Registry and validated by chart abstraction. Inclusion criteria for the arterial patency subgroup included an initial repair attempt with subsequent imaging reports (duplex ultrasound, CT angiography, and angiogram) documenting initial patency.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The cohort of 527 included 140 Veterans with available imaging studies for 143 arterial repairs; median follow-up from injury time to last available imaging study was 19 months (Q1\u2013Q3: 3\u201358; range: 1\u2013175). Injury mechanism was predominantly explosions (52%) and gunshot wounds (42%). Of the 143 arterial repairs, 81% were vein grafts. Eight repairs were occluded, replaced or included in extremity amputations. One upper extremity and three transtibial late amputations were performed for chronic pain and poor function averaging 27 months (SD: 4; range: 24\u201332). Kaplan-Meier analysis estimated patency rates of 99%, 97%, 95%, 91% and 91% at 3, 6, 12, 24, and 36 months, respectively, with similar results for upper and lower extremity repairs. Explosive and gunshot wound injury mechanisms had similar patency rates and upper extremity injuries repaired with vein grafts had increased patency.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Arterial repair mid-term patency in combat-related extremity injuries is excellent based on imaging studies for 143 repairs. Assertive attempts at acute limb salvage and vascular repair are justified with decisions for amputation versus limb salvage based on the overall condition of the patient and degree of concomitant nerve, orthopedic and soft tissue injuries rather than the presence of arterial injuries.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of evidence<\/jats:title>\n                  <jats:p>Therapeutic\/care management, level IV.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/tsaco-2020-000616","type":"journal-article","created":{"date-parts":[[2020,12,24]],"date-time":"2020-12-24T11:22:29Z","timestamp":1608808949000},"page":"e000616","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Patency of arterial repairs from wartime extremity vascular injuries"],"prefix":"10.1136","volume":"5","author":[{"given":"Lauren J","family":"Haney","sequence":"first","affiliation":[{"name":"Long School of Medicine, The University of Texas Health Science Center San Antonio, San Antonio, Texas, USA"},{"name":"South Texas Veterans Health Care System, San Antonio, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Bae","sequence":"additional","affiliation":[{"name":"South Texas Veterans Health Care System, San Antonio, Texas, USA"},{"name":"Surgery, Long School of Medicine, The University of Texas Health Science Center San Antonio, San Antonio, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Jo V","family":"Pugh","sequence":"additional","affiliation":[{"name":"VA Salt Lake City Health Care System, Salt Lake City, Utah, USA"},{"name":"Internal Medicine, The University of Utah School of Medicine, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurel A","family":"Copeland","sequence":"additional","affiliation":[{"name":"VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA"},{"name":"Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen-Pin","family":"Wang","sequence":"additional","affiliation":[{"name":"South Texas Veterans Health Care System, San Antonio, Texas, USA"},{"name":"Population Health Sciences, Long School of Medicine, The University of Texas Health Science Center San Antonio, San Antonio, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J","family":"MacCarthy","sequence":"additional","affiliation":[{"name":"South Texas Veterans Health Care System, San Antonio, Texas, USA"},{"name":"Population Health Sciences, Long School of Medicine, The University of Texas Health Science Center San Antonio, San Antonio, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan E","family":"Amuan","sequence":"additional","affiliation":[{"name":"VA Salt Lake City Health Care System, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9701-5422","authenticated-orcid":false,"given":"Paula K","family":"Shireman","sequence":"additional","affiliation":[{"name":"Surgery, Long School of Medicine, The University of Texas Health Science Center San Antonio, San Antonio, Texas, USA"},{"name":"Surgery, South Texas Veterans Health Care System, San Antonio, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,12,24]]},"reference":[{"key":"2025081710573952000_5.1.e000616.1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e31820752e3"},{"key":"2025081710573952000_5.1.e000616.2","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.jvs.2013.07.103","article-title":"Patient-Based outcomes and quality of life after salvageable wartime extremity vascular injury","volume":"59","author":"Scott","year":"2014","journal-title":"J Vasc Surg"},{"key":"2025081710573952000_5.1.e000616.3","doi-asserted-by":"crossref","first-page":"S104","DOI":"10.1097\/TA.0000000000001956","article-title":"Long-Term, patient-centered outcomes of lower-extremity vascular trauma","volume":"85","author":"Perkins","year":"2018","journal-title":"J Trauma Acute Care Surg"},{"key":"2025081710573952000_5.1.e000616.4","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1016\/j.jvs.2018.11.024","article-title":"Management and outcome of 597 wartime penetrating lower extremity arterial injuries from an international military cohort","volume":"70","author":"Sharrock","year":"2019","journal-title":"J Vasc Surg"},{"key":"2025081710573952000_5.1.e000616.5","doi-asserted-by":"crossref","first-page":"1872","DOI":"10.1016\/j.jvs.2018.04.038","article-title":"A contemporary, 7-year analysis of vascular injury from the war in Afghanistan","volume":"68","author":"Patel","year":"2018","journal-title":"J Vasc Surg"},{"key":"2025081710573952000_5.1.e000616.6","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.K.00734"},{"key":"2025081710573952000_5.1.e000616.7","doi-asserted-by":"crossref","first-page":"1470","DOI":"10.2106\/JBJS.18.00970","article-title":"The military extremity trauma Amputation\/Limb salvage (metals) study: outcomes of amputation compared with limb salvage following major upper-extremity trauma","volume":"101","author":"Mitchell","year":"2019","journal-title":"J Bone Joint Surg Am"},{"key":"2025081710573952000_5.1.e000616.8","doi-asserted-by":"crossref","first-page":"1612","DOI":"10.1056\/NEJMp1607636","article-title":"Wartime Lessons - Shaping a National Trauma Action Plan","volume":"375","author":"Rasmussen","year":"2016","journal-title":"N Engl J Med"},{"key":"2025081710573952000_5.1.e000616.9","unstructured":"The National Academies Press, National Academy of Science Engineering and Medicine . A National trauma care system: Integrating military and civilian trauma systems to achieve zero preventable deaths. 2016. https:\/\/www.nap.edu\/download\/23511# (04 Dec 2020)."},{"key":"2025081710573952000_5.1.e000616.10","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1053\/j.semvascsurg.2010.11.004","article-title":"Management of civilian and military vascular trauma: lessons learned","volume":"23","author":"Nguyen","year":"2010","journal-title":"Semin Vasc Surg"},{"key":"2025081710573952000_5.1.e000616.11","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s40719-014-0007-2","article-title":"Management of lower extremity vascular trauma","volume":"1","author":"Alam","year":"2015","journal-title":"Curr Trauma Rep"},{"key":"2025081710573952000_5.1.e000616.12","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e31827018e4"},{"key":"2025081710573952000_5.1.e000616.13","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1993.01420240076015"},{"key":"2025081710573952000_5.1.e000616.14","doi-asserted-by":"publisher","DOI":"10.1097\/01.TA.0000087807.44105.AE"},{"key":"2025081710573952000_5.1.e000616.15","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e31817e5132"},{"key":"2025081710573952000_5.1.e000616.16","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/0741-5214(94)90231-3","article-title":"Upper extremity arterial injuries: experience at the Royal Adelaide Hospital, 1969 to 1991","volume":"20","author":"Fitridge","year":"1994","journal-title":"J Vasc Surg"},{"key":"2025081710573952000_5.1.e000616.17","first-page":"265","article-title":"Long-Term outcomes after upper limb arterial injuries","volume":"40","author":"van der Sluis","year":"1997","journal-title":"Can J Surg"},{"key":"2025081710573952000_5.1.e000616.18","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1007\/BF02693799","article-title":"Determinates of functional disability after complex upper extremity trauma","volume":"15","author":"Brown","year":"2001","journal-title":"Ann Vasc Surg"},{"key":"2025081710573952000_5.1.e000616.19","doi-asserted-by":"publisher","DOI":"10.2147\/VHRM.S15316"},{"key":"2025081710573952000_5.1.e000616.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2009.06.054"},{"key":"2025081710573952000_5.1.e000616.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2010.02.017"},{"key":"2025081710573952000_5.1.e000616.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2009.03.051"},{"key":"2025081710573952000_5.1.e000616.23","doi-asserted-by":"publisher","DOI":"10.1177\/1531003506293374"},{"key":"2025081710573952000_5.1.e000616.24","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.avsg.2019.04.014","article-title":"Epidemiology of upper extremity vascular injury in contemporary combat","volume":"62","author":"Vuoncino","year":"2020","journal-title":"Ann Vasc Surg"},{"key":"2025081710573952000_5.1.e000616.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2008.01.052"},{"key":"2025081710573952000_5.1.e000616.26","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-198501000-00012"},{"key":"2025081710573952000_5.1.e000616.27","doi-asserted-by":"publisher","DOI":"10.1067\/mva.1991.28084"},{"key":"2025081710573952000_5.1.e000616.28","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1097\/00005373-199410000-00012","article-title":"Management of lower extremity arterial trauma","volume":"37","author":"Martin","year":"1994","journal-title":"J Trauma"},{"key":"2025081710573952000_5.1.e000616.29","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1097\/00000658-198712000-00020","article-title":"Long-Term results with autogenous tissue repair of traumatic extremity vascular injuries","volume":"206","author":"McCready","year":"1987","journal-title":"Ann Surg"},{"key":"2025081710573952000_5.1.e000616.30","doi-asserted-by":"publisher","DOI":"10.1067\/mva.1990.22790"},{"key":"2025081710573952000_5.1.e000616.31","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/S0741-5214(98)70290-3","article-title":"Management of severe proximal vascular and neural injury of the upper extremity","volume":"27","author":"Manord","year":"1998","journal-title":"J Vasc Surg"},{"key":"2025081710573952000_5.1.e000616.32","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.ejvs.2016.03.028","article-title":"Long-Term clinical outcome and functional status after arterial reconstruction in upper extremity injury","volume":"52","author":"Frech","year":"2016","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"2025081710573952000_5.1.e000616.33","doi-asserted-by":"crossref","first-page":"1633","DOI":"10.1016\/j.jvs.2014.01.006","article-title":"Outcome after interposition of vein grafts for arterial repair of extremity injuries in civilians","volume":"59","author":"Klocker","year":"2014","journal-title":"J Vasc Surg"},{"key":"2025081710573952000_5.1.e000616.34","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2008.05.007"},{"key":"2025081710573952000_5.1.e000616.35","doi-asserted-by":"publisher","DOI":"10.1007\/s10016-006-9090-3"},{"key":"2025081710573952000_5.1.e000616.36","doi-asserted-by":"crossref","unstructured":"Engel C , Simmons M , Heins S , Shen M , Azhar G , Piquado T . RAND Corporation . Limb Salvage and Recovery After Severe Blast Injury: Literature Review for the Eighth Department of Defense International State-of-the-Science Meeting on Blast Injury Research. 2020. https:\/\/www.rand.org\/pubs\/research_reports\/RRA199-1.html (09 Nov 2020).","DOI":"10.7249\/RRA199-1"},{"key":"2025081710573952000_5.1.e000616.37","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2482-15-13","article-title":"VA vascular injury study (VAVIS): VA-DoD extremity injury outcomes collaboration","volume":"15","author":"Shireman","year":"2015","journal-title":"BMC Surg"},{"key":"2025081710573952000_5.1.e000616.38","article-title":"Persistent pain, physical dysfunction, and decreased quality of life after combat extremity vascular trauma","author":"Haney","year":"2020","journal-title":"Ann Vasc Surg"},{"key":"2025081710573952000_5.1.e000616.39","first-page":"S5","article-title":"Utilizing a trauma systems approach to benchmark and improve combat casualty care","volume":"69 Suppl 1","author":"Eastridge","year":"2010","journal-title":"J Trauma"},{"key":"2025081710573952000_5.1.e000616.40","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-197403000-00001"},{"key":"2025081710573952000_5.1.e000616.41","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2006.07.009"},{"key":"2025081710573952000_5.1.e000616.42","article-title":"Reporting standards for endovascular aortic repair of aneurysms involving the renal-mesenteric arteries","author":"Oderich","year":"2020","journal-title":"J Vasc Surg"},{"key":"2025081710573952000_5.1.e000616.43","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e31819c59ac"},{"key":"2025081710573952000_5.1.e000616.44","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.ejvs.2009.11.019","article-title":"Repair of arterial injury after blunt trauma in the upper extremity - immediate and long-term outcome","volume":"39","author":"Klocker","year":"2010","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"2025081710573952000_5.1.e000616.45","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e318260aa54"},{"key":"2025081710573952000_5.1.e000616.46","doi-asserted-by":"crossref","first-page":"546","DOI":"10.7205\/MILMED-D-11-00422","article-title":"Evaluating the joint Theater trauma registry as a data source to benchmark casualty care","volume":"177","author":"O'Connell","year":"2012","journal-title":"Mil Med"},{"key":"2025081710573952000_5.1.e000616.47","first-page":"307","article-title":"Data quality and Interoperability challenges for eHealth exchange participants: observations from the Department of Veterans Affairs' virtual lifetime electronic record health pilot phase","volume":"2014","author":"Botts","year":"2014","journal-title":"AMIA Annu Symp Proc"},{"key":"2025081710573952000_5.1.e000616.48","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748-720X.2008.00322.x"},{"key":"2025081710573952000_5.1.e000616.49","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-6773.2005.00448.x"}],"container-title":["Trauma Surgery &amp; Acute Care Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/tsaco-2020-000616","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T17:57:54Z","timestamp":1755453474000},"score":1,"resource":{"primary":{"URL":"https:\/\/tsaco.bmj.com\/lookup\/doi\/10.1136\/tsaco-2020-000616"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12]]},"references-count":49,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,12,24]]},"published-print":{"date-parts":[[2020,12]]}},"alternative-id":["10.1136\/tsaco-2020-000616"],"URL":"https:\/\/doi.org\/10.1136\/tsaco-2020-000616","relation":{},"ISSN":["2397-5776"],"issn-type":[{"value":"2397-5776","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12]]}}}