Russia

Historical Background

Russian surgeons have made significant contributions to vascular surgery. After Nikolai Pirogov, one of the founders of military surgery, investigated vascular trauma and published one of the first atlases on vascular anatomy, many Russian surgeons have contributed to the field of vascular trauma: the portocaval anastomosis by Nikolai Ekk (1877), a lateral arterial suture by Alexander Yassinovsky (1899), blood pressure “sounds” of Nikolai Korotkov (1905), first suturing of the ascending aorta by Yustin Dzhanelidze (1913), the first heart-lung machine by Sergey Brukhonenko (1920), the first vascular circular-suturing device by Vasilij Gudov (1945), and kapron temporary intravascular shunts (TS) by Colonel Boris Matveev (1959). After WWII, vascular centers and units (Boris Petrovsky, Petr Kupriyanov, Alexander Shalimov, Victor Savel'ev, Anatoly Pokrovsky, etc.) were established in big cities. Post-WWII achievements include the first temporary balloon occlusion of the internal carotid artery for selective cerebral angiography and detachable balloons by Fedor Serbinenko (1969), and the invention of the stent graft and its first implantation for blunt traumatic aortic pseudoaneurysm by Nikolai Volodos (1987). Endovascular surgery in Russia derived from vascular surgery and is nowadays a separate specialty covering all the issues of neuro-, cardiac, and peripheral interventions. In turn, open vascular surgery has been significantly improved during recent armed conflicts.

Russian military medics provided care to casualties during the Soviet War in Afghanistan (1979–89; SWA), counter-terrorist operations in the North Caucasus region (1994–96, 1999–2002; CO-NC), and lately in Syria (since 2015; CO-S).

Epidemiology

The rate of major vascular injuries has increased from 4.5% in SWA to 6% in CO-NC to 10% in CO-S, reaching the numbers reported by other investigators. Extremity artery injuries prevailed in all conflicts due to “mine war,” accounting for 80% to 90% of all vascular cases. Carotid artery injuries occurred in less than 5% of cases, with the remaining 5% to 15% being torso vascular injuries.