Original article Outcome after vascular trauma in a deployed military trauma system A. Stannard, K. Brown, C. Benson, J. Clasper, M. Midwinter and N. R. Tai Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham Research Park, Vincent Drive, Birmingham B15 2SQ, UK Correspondence to: Lieutenant Colonel N. R. Tai (e-mail: nigel.tai@bartsandthelondon.nhs.uk) Background: Military injuries to named blood vessels are complex limb- and life-threatening wounds that pose significant difficulties in prehospital and surgical management. The aim of this study was to provide a comprehensive description of the epidemiology, treatment and outcome of vascular injury among service personnel deployed on operations in Afghanistan and Iraq. Methods: Data from the British Joint Theatre Trauma Registry were combined with hospital records to review all cases of vascular trauma in deployed service personnel over a 5-year interval ending in January 2008. Results: Of 1203 injured service personnel, 110 sustained injuries to named vessels; 66 of them died before any surgical intervention. All 25 patients who sustained an injury to a named vessel in the abdomen or thorax died; 24 did not survive to undergo surgery and one casualty in extremis underwent a thoracotomy, but died. Six of 17 patients with cervical vascular injuries survived to surgical intervention; two died after surgery. Of 76 patients with extremity vascular injuries, 37 survived to surgery with one postoperative death. Interventions on 38 limbs included 19 damage control procedures (15 primary amputations, 4 vessel ligations) and 19 definitive limb revascularization procedures (11 interposition vein grafts, 8 direct repairs), four of which failed necessitating three amputations. Conclusion: In operable patients with extremity injury, amputation or ligation is often required for damage control and preservation of life. Favourable limb salvage rates are achievable in casualties able to withstand revascularization. Despite marked progress in contemporary battlefield trauma care, torso vascular injury is usually not amenable to surgical intervention. Presented in part to the Annual Meeting of the Vascular Society of Great Britain and Ireland, Bournemouth, UK, November 2008, and published in abstract form as Br J Surg 2009; 96(Suppl 1): 6 Paper accepted 19 October 2010 Published online 19 November 2010 in Wiley Online Library (www.bjs.co.uk). DOI: 10.1002/bjs.7359 Introduction Among soldiers who die from combat injury, exsanguination from major vascular trauma endures as the leading cause of death 1–3 . Many of these injuries prove fatal well before the casualty reaches organized surgi- cal care, and survivorship bias ensures that only a small minority of combat casualties need treatment for vas- cular injury. Two of the largest series from the recent conflicts in Afghanistan and Iraq have documented a 4·4–7 per cent prevalence of vascular trauma 3–5 . These and other contemporary reports are generally limited to descriptions of patients who survived to reach surgi- cal care 6–11 . As a consequence, the casualties who die before the opportunity for surgical intervention are poorly described. Any systematic effort to improve salvageability from vascular trauma must include the entire population in order to understand where gains in survival of life and limb can be made. British servicemen and women have been deployed to Afghanistan since 2001 and to Iraq since 2003. Acute trauma care for these troops from the point of injury, through initial resuscitation, surgery, evacuation and definitive treatment, has been organized into an integrated United Kingdom Joint Theatre Trauma System (JTTS) 12 . A central part of this effort concerns the improvement of injury mitigation systems, surgical  2010 British Journal of Surgery Society Ltd British Journal of Surgery 2011; 98: 228–234 Published by John Wiley & Sons Ltd