**4. Incidence**

It is difficult to determine the true incidence of FTA. Some series combine iatrogenic with traumatic lesions. During World War II Elkin and Shumacker noted that there were 558 (22.58%) FTA and TAVF among the total 2471 vascular injuries [6]. According to Hughes and Jahnke's data, 215 cases of TAVF and FTA were described during the Korean conflict [7]. The largest series of surgically treated combat-related vascular injuries of about 1000 cases was published by Rich after the Vietnam war. They included 558 (incidence 55.8%) TAVF and FTA [8]. The first large civilian series of traumatic AVF and false aneurysms were published by Pattman et al. in 1964 [9], and Hewitt et al. in 1973 [10]. The incidence of TAVF and FTA was 2.3% (6/256) in the first study and 6.8% (14/206) in the second. According to experience of Davidović et al, is not that low. The incidence of TAVF and FTA, which included 140 cases, was 17.85%, and in civilian study with 273 cases it was 21.24% [11].

The most frequent cause of penetrating wounds during wars, as under civilian conditions, are bullets (figure 1) and fragments from various exploding devices (figure 2). In civilian experience, FTA and TAVF result from stab wounds as well [12]. FTA can also be caused by secondary damage, followed by pathologic moving of a bone fracture after penetrating and blunt trauma. In Davidović et al study, most of the FTA (superficial femoral 23.4% and popliteal 19.15%) were found at vessels near long bones (figure 3 and 4) [13]. Blunt trauma without associated bone fracture can also result in FTA and [14-16] (figure 5).

**Figure 1.** FTA after gun-shut injury

**Figure 2.** FTA and multifragments in right limb

**4. Incidence** 

**Figure 1.** FTA after gun-shut injury

operated on a young male patient with a large FTA of the brachial artery that had developed after multiple gunshots [2]. After ligation of the main proximal and distal arteries, he opened the aneurysm sac and sutured all collaterals with back-bleeding. Fifteen years later, Matas described this procedure as a reconstructive endoaneurysmorrhaphy [3]. Vojislav Soubbotich, a Serbian surgeon treated 60 FTA and 17 traumatic arteriovenosum fistulas (TAVF) during the Balkan wars between 1912 and 1913. He performed some of the reconstructive procedures in 32 cases [4]. Rich published an interesting article titled, ''Matas Soubottich Connection.'' He said that Soubbotich's technique and results had been outrun 40 years later, during the Korean conflict [5].

It is difficult to determine the true incidence of FTA. Some series combine iatrogenic with traumatic lesions. During World War II Elkin and Shumacker noted that there were 558 (22.58%) FTA and TAVF among the total 2471 vascular injuries [6]. According to Hughes and Jahnke's data, 215 cases of TAVF and FTA were described during the Korean conflict [7]. The largest series of surgically treated combat-related vascular injuries of about 1000 cases was published by Rich after the Vietnam war. They included 558 (incidence 55.8%) TAVF and FTA [8]. The first large civilian series of traumatic AVF and false aneurysms were published by Pattman et al. in 1964 [9], and Hewitt et al. in 1973 [10]. The incidence of TAVF and FTA was 2.3% (6/256) in the first study and 6.8% (14/206) in the second. According to experience of Davidović et al, is not that low. The incidence of TAVF and FTA, which included 140 cases, was 17.85%, and in civilian study with 273 cases it was 21.24% [11].

The most frequent cause of penetrating wounds during wars, as under civilian conditions, are bullets (figure 1) and fragments from various exploding devices (figure 2). In civilian experience, FTA and TAVF result from stab wounds as well [12]. FTA can also be caused by secondary damage, followed by pathologic moving of a bone fracture after penetrating and blunt trauma. In Davidović et al study, most of the FTA (superficial femoral 23.4% and popliteal 19.15%) were found at vessels near long bones (figure 3 and 4) [13]. Blunt trauma

without associated bone fracture can also result in FTA and [14-16] (figure 5).

**Figure 3.** False traumatic aneurysm of the left-side brachial artery developed after a stab injury, which was accidental, job-related, and self- inflicted. a Angiography. b Intraoperatively, a laceration is apparent on the front wall of the brachial artery

**Figure 4.** False traumatic aneurysm of the right-side axillary artery developed as the result of a gunshot injury

Lesions of the intrathoracic segment of the supraaortic branches can be often fatal. Formation of an FTA is not uncommon [17,18]. In 1968, Vollmar and Krumhaar described two such cases among 200 FTA, while Beall et al [19], Rich et al. [5], and Davidović et al [13] found only one such case (figure 6). In the most important war studies published between 1946 and 1975, all carotid arteries (common, external, internal) were involved in 3.8–20.5% of cases [6-8,20]. The incidence of all carotid arteries (common, external, internal) being involved, according to two of the most important civilian studies published during the same period, was 14.3–18% [10,12,13,21] (figure 6, 7 and 8).

In all of these studies FTA were mainly associated with lower extremity vessel (46.0– 69.46%).6-13, 20

408 Aneurysm

injury

**Figure 4.** False traumatic aneurysm of the right-side axillary artery developed as the result of a gunshot

Lesions of the intrathoracic segment of the supraaortic branches can be often fatal. Formation of an FTA is not uncommon [17,18]. In 1968, Vollmar and Krumhaar described two such cases among 200 FTA, while Beall et al [19], Rich et al. [5], and Davidović et al [13] found only one such case (figure 6). In the most important war studies published between 1946 and 1975, all carotid arteries (common, external, internal) were involved in 3.8–20.5% of cases [6-8,20]. The incidence of all carotid arteries (common, external, internal) being involved, according to two of the most important civilian studies published during the same

period, was 14.3–18% [10,12,13,21] (figure 6, 7 and 8).

**Figure 5.** FTAof temporal artery after blunt injury

**Figure 6.** False traumatic aneurysm (arrowhead) of the left common carotid artery (arrow) developed after blunt trauma

**Figure 7.** a Angiography reveals a false traumatic innominate artery aneurysm (arrow) that developed after chest blunt trauma during a car accident. b Note the right common carotid artery (white arrow) and the closed proximal end of the innominate artery (black arrow)

**Figure 8.** a Dacron bypass graft from the ascending aorta to the right common carotid and right subclavian artery. An 8-mm ringed polytetrafluoroethylene (PTFE) graft has been used to repair the injured left brachiocephalic vein. b MSCT performed 1 month later showed that both Dacron and PTFE grafts are patent
