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Zentralbl Chir 2018; 143(05): 466-474
DOI: 10.1055/a-0713-0833
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Management von Gefäßverletzungen bei militärischen Konflikten und Terroranschlägen

Management of Vascular Trauma in Military Conflicts and Terrorist Attacks
Michael Engelhardt
1   Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Bundeswehrkrankenhaus Ulm, Deutschland
,
Kristoffer Elias
2   Klinik für Gefäßchirurgie, Ammerland Kliniken GmbH, Westerstede, Deutschland
,
Sebastian Debus
3   Gefäßchirurgie, Universitäres Herzzentrum, Hamburg, Deutschland
,
Christoph Zischek
1   Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Bundeswehrkrankenhaus Ulm, Deutschland
› Author Affiliations
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Publication History

Publication Date:
24 October 2018 (online)

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Zusammenfassung

Im Krieg und bei Terroranschlägen erleiden bis zu 12% aller Verwundeten schwere Gefäßverletzungen. Die Entwicklungen in der Gefäßtraumatologie sind daher eng mit den bewaffneten Konflikten des 20. und 21. Jahrhunderts verknüpft. In diesem Beitrag werden anhand der historischen Erfahrungen militärchirurgische Aspekte bei Gefäßverletzungen diskutiert und die aktuellen Standards der Militärchirurgie auf diesem Gebiet dargestellt. Während bis einschließlich zum Zweiten Weltkrieg verletzte Gefäße überwiegend ligiert werden mussten, konnte erstmals im Korea- und Vietnamkrieg ein hoher Anteil der Gefäßverletzungen erfolgreich rekonstruiert werden. Zusammen mit der verbesserten Evakuierung durch Einsatz von Hubschraubern führte dies zu einer Reduzierung der Amputationsrate von fast 50% auf unter 15%. Nach wie vor ist jedoch das Verbluten die Hauptursache vermeidbarer Todesfälle auf dem Schachtfeld. Die standardmäßige Einführung von Tourniquets, Hämostyptika und Ballonokklusion der Aorta haben die Überlebenschancen verbessert. Das Damage-Control-Prinzip ist insbesondere bei Forward Surgical Teams unverzichtbar und der temporäre intravasale Shunt hat sich frontnah als gefäßchirurgische Damage-Control-Maßnahme längst durchgesetzt. Aufwendige Ausbildungskonzepte vieler Streitkräfte sichern die gefäßchirurgische Notfallkompetenz der stationierten Militärchirurgen. Die Militärchirurgie verfügt aus Krisen- und Kriegsgebieten über reichlich Erfahrung in der Versorgung von massiven Blutungen und schweren Gefäßverletzungen. Zahlreiche hierbei gewonnene Erkenntnisse und Techniken wurden im Laufe der Zeit in die zivile Chirurgie übernommen und aktuelle militärische Entwicklungen beeinflussen auch heute noch die zivile Traumaversorgung.

Abstract

In war and terror attacks, up to 12% of all casualties suffer a severe vascular injury. Therefore, management of vascular trauma is closely associated with lessons learned during the wars of the 20th and 21st century. This article discusses military aspects of vascular trauma based on historical developments and introduces current standards in military vascular surgery. Up to Word War II, ligation was the predominant therapy for severe vascular trauma. Beginning in the Korean and Vietnam Wars, arterial reconstruction became more and more feasible. This development – in conjunction with rapid helicopter evacuation – decreased the former amputation rate of almost 50% to less than 15%. Nevertheless, exsanguination still remains the major cause of death among casualties with potentially survivable injuries. Standard application of tourniquets, haemostyptica, and balloon occlusion of the aorta improved survival rate. Meanwhile, damage control principals are essential for Forward Surgical Teams and the use of temporary intravascular shunts is well implemented in combat settings. In many armed forces, sophisticated training programs ensure the necessary competence in vascular surgery for all military surgeons deployed. Military surgery provided ample evidence and experience in the management of major vascular trauma over the last century. Much of this knowledge has been translated to civilian health providers and ongoing developments in the military still influence the management of severe vascular trauma.

Schlüsselwörter

Gefäßverletzung - Gefäßchirurgie - Katastrophenmedizin - Tourniquet - REBOA - intravaskulärer Shunt

Key words

vascular injury - vascular surgery - catastrophe medicine - tourniquet - REBOA - intravascular shunt
 

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