Endovascular surgery in the French role 3 medical treatment facility: Is there a need? A 10-year retrospective analysis

Objective: Vascular surgery for war-related traumatic injuries represents 3 to 17.6 % of all emergency surgical procedures, and around 5 % in French Medical Treatment Facilities (MTFs). Most of these lesions are treated by open surgery, but the role of endovascular surgery in French MTFs has not been assessed yet. The aims of this study are to assess the possible role of endovascular surgery by describing vascular surgical management in recent conflicts, and identify potential gaps in vascular surgery training.

Methods: Data were extracted from the OPEX® registry, which recorded all surgical activity during deployment from 2011 to 2021. All patients treated in French Role 2 Enhanced or 3 MTFs requiring emergency surgery for peripheral vascular injury were included. The mechanism of injury, type of vascular injury and surgical management were reported. Patients eligible to receive endovascular surgery were described as a subgroup, and surgical management was described according to surgeon's specialty.

Results: Out of the 2137 patients admitted for emergency or delayed emergency surgery, we reported 21 patients (0.98 %) with peripheral vascular injuries requiring emergency surgery, of which 19 (90.5 %) with at least one arterial lesion. Most injuries were combat-related (n = 18 [86 %]). Arterial injuries involved mainly femoral (n = 8 [38.1 %]) or humeral (n = 5 [23.8 %]) arteries, primarily handled by vascular shunting or bypass. Arteriography before or after surgery was not a was not common practice (n = 4 [19 %]). Six patients (28.6 %) were deemed eligible for endovascular surgery.

Conclusion: Peripheral vascular lesion requiring emergency surgery are relatively uncommon in French MTFs. However, they require specific surgical training to deal with their complexity. Endovascular surgery does not appear to offer sufficient benefit for systematic deployment in French MTFs, and pre- and post-operative arteriography may be of interest for diagnostic use. The establishment of a French vascular mobile unit for complex cases may be of interest.