Vascular Trauma in Israel

Vascular trauma is common in Israel, as it is in other western societies; and it includes a variety of etiologies such as traffic accidents, extremity fractures, falls, gunshot wounds and, increasingly, iatrogenic causes. However, in addition to the regular civilian pattern of vascular injuries, Israel is involved in frequent armed conflicts; the civilian vascular community has to care for military-type injuries, such as penetrating wounds from bullets, from ball bearings, and from other fragments and foreign bodies from explosive devices. The Israeli experience in vascular trauma shows that injuries may be caused by blunt trauma; but more often they are the result of penetrating injuries and are the main causes of severe bleeding, ischemia, disabilities, amputations, and death. Vascular injuries take first priority in treatment paradigms since shortening of the time of bleeding and the time of ischemia are of paramount importance in saving limbs and lives of the injured. Identification of the specific injured arteries and veins allows accurate control of blood loss and allows appropriate repair of vessels. Use of fasciotomies in this setting should be liberal to prevent compartment syndrome and to improve functional outcome. To lessen the risk of infection and thrombosis, primary repair of vessels and use of autologous vein are preferred over the use of synthetic conduits. In the battlefield and during evacuation, rubber and improvised tourniquets are used to stop life-threatening bleeding; but in the setting of the operating room these should be removed as soon as possible to prevent continued ischemia of nerves and other soft tissues. In the modern specialized vascular facilities of Israel, the rate of success in repairs of vascular injuries is high; and the amputation rate is low and constantly continues to decrease. The mortality rate of those who reach a surgical facility is near zero.