Analysis of Vascular Trauma in Terror-Related Civilian AttacksWithin South-Eastern Turkey

Objective: To evaluate the results of terror related vascular injuries and predictors of mortality caused by these injuries in South-Eastern Turkey. Material and Methods: Eighty-eight patients (82 men, 24.4 ± 8.1 years) who had vasculary trauma in terrorist attacks between January 2012-August 2015 in South-Eastern Turkey included in this retrospective study. Patients with traumatic amputations, extensive tissue losses, amputations after severe nerve damage and head injuries were excluded. Study patients were analyzed according to the mechanism and severity of injury, location of trauma, and surgical treatment options. Results: Forty-six (52.3%) patients had lower limb, 19 (21.6%) patients had upper limb, 13 (14.8%) patients had both upper and lower limb vascular injuries. Other vascular injuries involved neck (n=3; 3.4%), thorax (n=2; 2.3%), abdomino-pelvic (n=5; 5.7%) locations. Twenty-three (26.1%) of them were caused by bullets, 54 (61.4%) by shrapnel and 11 (12.5%) by bombs and explosions. Thirty-eight (43.2%) of these patients were in hypovolemic shock at admittance. Forty patients (45.5%) had isolated arterial, 42 (47.7%) patients had both artery and vein, 6 (6.8%) patients had isolated vein injuries. Autogenous grafts were used in 28 (31.8%) patients, and synthetic grafts were used in 10 (11.4%) patients. Vascular ligations were performed in 18 (20.5%) patients. Seven (8%) patients had acute renal injury and 28 (31.8%) patients had wound infections postoperatively. Overall in-hospital mortality rate was 18.2% (16 patients). Hypovolemic shock (p<0.0001), acute renal failure (p=0.002) and massive blood transfusion (p=0.007) were the main predictors of mortality. Conclusion: Vascular injuries in terror-related trauma victims require multidisiplinary urgent treatment of hypovolemic shock, preventive measures to avoid acute renal failure and immediate complex vascular surgery.