Evaluation and Management of Peripheral
Vascular Injury
Part 1

Historic Perspective

Urgent repair of an injury to the brachial artery was first performed by Hallowell on June 13, 1759, at the site of a “blood letting.”5 After a 145-year delay, techniques of arterial repair were developed by Nobel Prize winner (1912) Alexis Carrel and Charles C. Guthrie at the University of Chicago from 1904 to 1906.6 Operative repairs of arterial injuries in the early part of the 20th century, most performed in a delayed fashion after wounding, were reported by V. Soubbotitch in the Balkan Wars, George H. Makins in World War I, and R. Weglowski during the Polish-Russian War of 1920.7–9 Less than 150 arterial repairs in American military personnel during World War II were reported by DeBakey and Simeone10 in their classic review published in 1946. This small number was a reflection of the magnitude of military wounds, delays in medical care, lack of antibiotics, and the significant risk of late infection in injured soft tissues of the extremities. Vascular repairs were performed frequently in the later stages of the Korean War and routinely throughout the Vietnam War.11,12 Over the past 50 years, urban trauma centers in the United States have treated an extraordinary number of patients with arterial injuries from gunshot wounds.3