Russia

We present our experience of treating patients with vascular injuries during the Soviet War in Afghanistan (1979–89), the conflicts in the North Caucasus of Russia (1994–96, 1999–2002), and in Syria (since 2015). The rate of vascular injuries among all injured combatants in Afghanistan amounted to 4.5%, in the North Caucasus to 6%, and reached 10% during the latest operations. Time to initial surgery has decreased from 4 to 6 hours to 2 to 3 hours. For better combat casualty care, prehospital blood transfusions, massive transfusion protocols, and damage control resuscitation techniques were widely adopted. The surgical strategy for vascular cases was based on a modern classification of acute limb ischemia, Doppler/duplex scanning, and angiography. The number of artery ligations decreased from 31% in Afghanistan to 16% in the North Caucasus, and are now exceptionally rare. The use of temporary shunting has increased from 17% in Afghanistan to 25% in the North Caucasus and about 40% in Syria (for common or local damage control). During the latest conflict, for the first time in Russian history, endovascular techniques, including formal angiography, REBOA, and stent-graft placement, were used in a combat zone. Among vascular injury patients in Afghanistan, 88% of patients survived, 33% returned to duty, while 43% of patients recovered with either good or satisfactory results. During the North Caucasus conflict, the rate of secondary amputations did not exceed 4% to 5%. Infectious complications occurred in 12.4% of patients with vascular injuries. Total mortality amounted to 10%. More than half of all vascular patients (58%) returned to duty.