Tresson P, Touma J, Gaudric J, Pellenc Q, Le Roux M, Pierret C, Kobeiter H, Julia P, Goeau-Brissonniere O, Desgranges P, Koskas F, Castier Y. Ann. Vasc. Surg. 2017; 40: 44-49.
Affiliation
Service de chirurgie vasculaire et thoracique, Hôpital Bichat, AP-HP, Faculté de médecine Denis Diderot, Université Paris 7, Paris, France. Electronic address: yves.castier@bch.aphp.fr.
OBJECTIVES: On November 13, 2015, Paris and Saint-Denis were the targets of terrorist attacks. The hospitals of the Public Hospitals of Paris Organization (AP-HP) and the Percy Armed Forces Instruction Hospitals were mobilized to face the mass casualty situation. The objective of this study was to analyze the management of the victims presenting with a non-thoracic vascular trauma (NTVT). MATERIAL AND METHODS: All the data relating to the victims of NTVT who required a specific vascular open or endovascular treatment were analyzed retrospectively. A six months follow-up was obtained for all the patients.
RESULTS: Among the 351 wounded, 20 (5.7%) had a NTVT and were dispatched in eight hospital (11 men of average age 32). NTVT were gunshots in 17 cases (85%) or due to a handmade bomb in three cases (15%). Twelve patients (60%) received cardiopulmonary resuscitation during prehospital care. NTVT affected the limbs (14 cases, 70%) and the abdomen or the small pelvis (six cases, 30%). All the patients were operated in emergency. Arterial lesions were treated with greater saphenous vein bypasses, by ligation and/or embolization. Eleven venous lesions were treated by direct repair or ligation. Associated lesions requiring a specific treatment were present in 19 patients (95%) and were primarily osseous, nervous and abdomino-pelvic. Severe postoperative complications were observed in nine patients (45%). Fourteen patients (70%) required blood transfusion (6.4 units of packed red blood cells on average, range 0-48). There were no deaths or amputation and all vascular reconstructions were patent at six months.
CONCLUSION: The effectiveness of the prehospital emergency services and a multi-sites and multidisciplinary management made it possible to obtain satisfactory results for NTVT casualties. All the departments of vascular surgery must be prepared to receive many wounded victims in the event of terrorist attacks.