Background. Vascular injuries often result in life threatening hemorrhage or limb loss. When they present with a single entry or exit wound, surgery is immediately indicated. With multiple injuries, however, imaging such as CTA is necessary for diagnosis and choice of treatment. Methods. For all combat-related vascular cases admitted to our medical center during the Lebanon wars in 1982 and 2006, we compiled and compared presenting signs and symptoms, means of diagnosis, treatments, and results. Results. 126 patients with vascular injuries were admitted (87 in 1982, 39 in 2006). 90% were male; mean age of 29 years (range 20–53). All injuries were accompanied by insult to soft tissue, bones, and viscera. 75% presented with injury to arteries in the extremities. 75% of these patients presented with limb ischemia, and 25% sustained massive blood loss. Treatments included venous interposition graft, end-to-end anastomosis, venous patch, endovascular technique (only in 2006), and ligation/observation. Complications included thrombosis and wound infections. Mortality and amputations occurred only in 1982, and this may be attributed to the use of imaging, advanced technique, and shorter average time from injury to hospital (7 hours). Conclusions. We recommend CTA as the first line modality for diagnosis of vascular injuries, as its liberal use allowed for early and appropriate treatment. Treatment outcomes improved with fast and effective resuscitation, liberal use of tourniquets and fasciotomies, and meticulous treatment by a multidisciplinary team. 1. Patients and Methods During the first conflict in Lebanon, from June 6to September 17 1982, there were 2,176 wounded patients and during the 33-day conflict in Lebanon, from July 12 to August 15 2006, 511 wounded patients (soldiers and civilians) were admitted to our Emergency Room, out of which 87 (4%) and 39 (7.6%), respectively, had sustained a major vascular injury. There was male predominance of 92% wounded males and only 8% females. Their mean age was 29 years (range 20–53 years). All injuries were penetrating secondary to small arms used in direct combat, high velocity missiles, shrapnel, or multiple pellets stored in long range missiles (Figure 1). All injuries were accompanied by additional insult to soft tissue, bones, and viscera. Each patient suffering a vascular trauma had an average of 2.5 additional injuries. The mean injury severity score was 16 (range 9–38), similar in both groups. Figure 1: A car after fire of shrapnel or multiple pellets stored in long range missiles demonstrating the density
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