The majority of vascular trauma in USA, South America and military conflict areas in Europe was penetrating trauma reaching up to 90% in some reports [15–17]. The actual incidence of vascular trauma in most European countries is unknown. Finland has an

annual incidence of 1.3 per 100,000 inhabitants while Sweden has an incidence of 2.3 per 100,000 inhabitants [9]. Our incidence of major vascular trauma due to road traffic collisions alone is 1.87 cases/100 000 inhabitants per year. The studies from Sweden and Finland included all vascular injury patients admitted to hospitals. About 20% were caused by blunt trauma. In contrast our study was limited only to hospitalized vascular injury in road traffic collisions. Only 34% of trauma in our community is caused by RTC which indicates that this website vascular trauma in general is even much higher than Finland and Sweden [18]. It may be argued that the number of patients of this study is small. Nevertheless we think that the data was very accurate as it captured prospectively

all injuries in all age groups with their detailed mechanism of injury in a specific population over a specific time. Analyzing the biomechanics of crashes is important. About 90% of injuries can be clinically predicted if the biomechanics of RTC was well understood [19]. This will help reducing missed injuries. It is important to note that the majority of vascular injuries were in the upper part of the body MI-503 purchase (upper limb and thorax) similar to other studies [9, 12, 20]. All thoracic aortic injuries in our study occurred in pedestrians hit by moving vehicles. These are acceleration injuries in which the moving aortic arch is accelerated compared to the

fixed part. We have recently shown that injury severity of RTC patients was higher for non vehicle occupants especially pedestrians, who also accounted for most deaths [5]. The risk of thoracic aortic injury was significantly higher with side-impact crashes and particularly if the occupants were unbelted [21] because side impact hits the weak side of the vehicle. None of our car occupants was wearing seatbelts. If an occupant was not restrained and had a front impact collision, he/she will lean forward [22–24] and may try to protect him/herself with his/her upper limbs leading to their fracture and major vascular injuries of the upper limbs as they cannot tolerate the impact of energy Defining Histamine H2 receptor the incidence and mechanism of vascular trauma would help in adopting preventive strategies and directing resources in this part of the world. Trauma centers should be well equipped with an angiographic suite, interventional radiologists, and a vascular team to optimize clinical outcome of these life-threatening situations. The most affordable, effective and cheapest way to reduce the burden of injury is prevention [25]. Injury prevention is usually highly cost effective saving both medical costs and lives [26]. We should adopt an epidemiological approach if we are serious in preventing these injuries.