Saving limbs and lives: Vascular lessons from the combat zone.

Pediatric traumatic vascular injuries are challenging to manage due to their relatively infrequent occurrence, requirement of emergent intervention when identified, and the divergent training pathways in pediatric surgery and vascular surgery. Together, these factors contribute to confusion and lack of confidence in surgeons caring for pediatric vascular trauma patients. Many of the principles and tools of both adult and pediatric vascular surgical disciplines have come from the military world, and while these injuries previously often resulted in amputation or death, advances since World War I have improved outcomes. Military improvements such as tourniquets, endovascular balloon occlusion, damage control surgery, and temporary intravascular shunting are used in the civilian pediatric vascular surgery world routinely to save limbs and lives.