ABSTRACT
Injuries to major arteries and veins were managed surgically and documented in isolated case reports or small clinical series during the late 1800s and early 1900s. The standardization of anastomotic techniques as described by Carrel, Guthrie, Murphy, Frouin, and others[1] represented a remarkable achievement, which, however, was not applied clinically in any large number of cases until the post-World War II era. Experience with vascular trauma was documented by DeBakey and Simeone[2] during World War II. These authors reported on the management of 2471 arterial injuries, only 3.3% of which were treated by vascular repair. Lateral arteriography was the principal means of repair, while only 3 of 81 cases were managed by end-to-end anastomosis. It was not until the Korean War that clinical experience suggested the feasibility of vascular reconstruction in the battlefield environment.[3-5] Of major importance was the efficiency of the medical evacuation system, which resulted in arrival of injured patients at definitive treatment centers well within the preferred 6-to 8-h time limit associated with improved success after vascular reconstruction. The availability of typespecific blood replacement and antibiotics as well as a better understanding of the resuscitation of the injured patient were important factors resulting in successful management and were applied to the civilian experience thereafter. The acceptance of vascular reconstruction for trauma during the Vietnam War and the careful clinical follow-up afforded by the Vietnam Vascular Registry confirmed the impression that these injuries were best treated by prompt surgical management.
