An Endovascular Surgery Experience in Far-Forward Military Healthcare-A Case Series

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An Endovascular Surgery Experience in Far-Forward Military Healthcare-A Case Series


JournalMilitary medicine
Publication date – Aug – 2020
Authors – Daniel J Coughlin, Jason H Boulter, Charles A Miller, Brian P Curry, Jacob Glaser, Nathanial Fernandez, Randy S Bell, Albert J Schuette
KeywordsEndovascular surgery, Interventional neuroradiology
Open access – Yes
SpecialityVascular surgery
World region Central Asia
Country: Afghanistan
Language – English
Submitted to the One Surgery Index on August 25, 2020 at 3:41 am
Abstract:

Introduction: The advancement of interventional neuroradiology has drastically altered the treatment of stroke and trauma patients. These advancements in first-world hospitals, however, have rarely reached far forward military hospitals due to limitations in expertise and equipment. In an established role III military hospital though, these life-saving procedures can become an important tool in trauma care.

Materials and methods: We report a retrospective series of far-forward endovascular cases performed by 2 deployed dual-trained neurosurgeons at the role III hospital in Kandahar, Afghanistan during 2013 and 2017 as part of Operations Resolute Support and Enduring Freedom.

Results: A total of 15 patients were identified with ages ranging from 5 to 42 years old. Cases included 13 diagnostic cerebral angiograms, 2 extremity angiograms and interventions, 1 aortogram and pelvic angiogram, 1 bilateral embolization of internal iliac arteries, 1 lingual artery embolization, 1 administration of intra-arterial thrombolytic, and 2 mechanical thrombectomies for acute ischemic stroke. There were no complications from the procedures. Both embolizations resulted in hemorrhage control, and 1 of 2 stroke interventions resulted in the improvement of the NIH stroke scale.

Conclusions: Interventional neuroradiology can fill an important role in military far forward care as these providers can treat both traumatic and atraumatic cerebral and extracranial vascular injuries. In addition, knowledge and skill with vascular access and general interventional radiology principles can be used to aid in other lifesaving interventions. As interventional equipment becomes more available and portable, this relatively young specialty can alter the treatment for servicemen and women who are injured downrange.

OSI Number – 20631
PMID – 32812042

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