Vascular surgery experience for major vascular injuries in the Beirut Blast: Lessons learned

Abstract

Background

The Beirut Port Blast on August 4, 2020, was the largest non-nuclear blast in history. It heavily affected the fragile population already facing an ongoing political and socioeconomic crisis, and the coronavirus diease 2019 pandemic. This article is a review of major vascular injury patterns and mechanism, strategies of treatment, and physician experience.

Methods

This retrospective review was performed on all patients who presented to the Lebanese American University Medical Center—Rizk Hospital after the Beirut Blast owing to vascular injuries. All patients presenting with major vascular injuries requiring admission, operations, or who were deceased owing to vascular injuries were included. Basic identification and medical history data were extracted. The surgical procedures and postoperative care and outcomes were also recorded.

Results

Eigtheen patients who presented to our institution during the day of the blast were included. Two patients passed away in the emergency room. The remaining 16 patients required surgeries. Most vascular injuries were caused by debris and shattered standard glass. The location of the vascular injuries were diverse; six patients (33.3%) had neck injuries, nine patients (50%) had upper extremity injuries, and three patients (16.6%) had lower extremity injuries. Furthermore, all patients had venous injuries (100%), and nine patients (50%) had arterial injuries.

Conclusions

After the Beirut Blast, the major vascular injury seen was in the upper extremity, followed by the neck and lower extremity, mostly owing to shattered nonlaminated glass. Laminated or tempered glass should be considered superior to standard nonlaminated glass during Beirut renovation and areas at high risk for bombing, wars, and natural disasters like earthquakes. Awareness and knowledge of bleeding control is a must for people living in such risky environments. Venous injuries were more common and managed safely by ligation. Arterial injuries required a more extensive approach based on the location and extent of injury, but damage control surgery remains the mainstay strategy in disastrous situations.