Common femoral, superficial femoral, and brachial arteries were the most common injured arteries in our study. This is similar to other reports. In Vietnam Vascular Registry, the superficial femoral and brachial arteries were the most common injured arteries [5]. Similarly, Fox

et al. reported involvement of superficial femoral and brachial arteries in 44% of their cases [7]. Among 6808 reported vascular injuries in the literature, femoral artery injury was the most common (35%) followed by the brachial (31%) and then popliteal artery injuries (19.5%) [11]. Balad Vascular Registry see more from Iraq war included 90 femoral arteries and 44 popliteal arteries [12]. That is different from blunt vascular injuries caused by road traffic collisions in civilian practice, in which brachial artery is the most common injured vessel [8]. Arterial primary repair was the most common method of repair in our study (12/31). Only seven patients have their arterial repair performed

with reversed saphenous vein graft. In contrast, most studies recommended using the interposition vein graft [7, 13]. Experienced vascular and transplant surgeons were available through the whole war period in our hospital explaining the variation of techniques used in our study. Management of arterial repair with autologous vein graft remains the most durable and effective means of vascular repair [7, 13]. Arterial injuries usually MK-2206 in vivo have a segmental arterial loss preventing tensionless primary anastomosis. Ligation of arterial injuries is a good strategy only in selected vessels. In our study, ligation of the radial, ulnar and tibial arteries did not cause ischaemia of the involved limbs. Examination of extremities SB-3CT after ligation is important to confirm limb

viability. Prosthetic grafts were not used in any of our patients. Using prosthetic grafts remains a controversial issue because they are associated with increased risk of infection and consequently poor outcome [5, 14]. Ligation of injured veins was commonly used during war [5, 15]. However, in our series only four out of 17 venous injuries had ligation. This can be also explained by the presence of experienced vascular surgeons in our hospital. Venous repair remains a controversial issue in patients with vascular injuries. However, most would agree that venous repair by means, other than simple lateral suturing and end-to-end anastomosis, is a time- consuming process with uncertain benefits especially in multiply injured patients [5]. In our series most patients with venous injury underwent simple lateral repair or ligation if the first option was not possible. Primary amputation was performed mainly because of mangled extremity with massive tissue loss, and bone injury, while secondary amputation was related to delayed presentation and infectious complications. Wani et al. treated 360 war-related arterial injuries over 13 years in Kashmir [16].