Outcomes after Arterial Reconstruction with Autogenous Vein Graft for Limb Salvage in Traumatized Extremity

Archives of Hand and Microsurgery ◽

10.12790/ahm.21.0092 ◽

2021 ◽

Author(s):

Mooheon Jeon ◽

Young Keun Lee

Keyword(s):

Limb Salvage ◽

Vein Graft ◽

Arterial Reconstruction ◽

Ischemic Time ◽

Efficient Treatment ◽

Tibial Artery ◽

Severity Scores ◽

Limb Injuries ◽

Autogenous Vein ◽

Artery Reconstruction

Purpose: The patients with major vascular injuries in the traumatized extremity and underwent arterial reconstruction using autogenous vein grafts for limb salvage. This study aims to report the outcomes of arterial reconstruction with autogenous vein graft in patients.Methods: From February 2015 to April 2017, a study was retrospectively analyzed 13 patients with limb injuries caused by significant arterial damage and underwent arterial reconstruction using vascular autografts for limb salvage. Such as cause, Mangled Extremity Severity Scores (MESS), ischemic time, length of the grafted vein, reconstructed arterial status, and survival status were analyzed. Results: Among the patients analyzed, nine patients’ injuries were caused by traffic accidents and three industrial accidents, one fall down. Mean MESS was 6.2 (range, 5–8) and mean ischemic time was 12.3 hours (range, 5–25 hours). As arterial reconstruction, seven patients underwent posterior tibial artery reconstruction, three underwent popliteal artery reconstruction, two underwent anterior tibial artery reconstruction, and one underwent radial artery reconstruction; the greater saphenous vein was grafted in 12 reconstruction cases. Mean length of the grafted vein was 4.9 cm (range, 3–10 cm). All patients have salvaged injured limbs.Conclusion: Artery reconstruction using autogenous vein graft is an efficient treatment method when vascular damage cannot be directly repaired during limb salvage.

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Comparison of propaten heparin-bonded vascular graft with distal anastomotic patch versus autogenous saphenous vein graft in tibial artery bypass

Vascular ◽

10.1177/1708538117717141 ◽

2017 ◽

Vol 26 (2) ◽

pp. 117-125 ◽

Cited By ~ 3

Author(s):

Jeremy Kaisar ◽

Aaron Chen ◽

Mathew Cheung ◽

Elias Kfoury ◽

Carlos F Bechara ◽

...

Keyword(s):

Limb Salvage ◽

Saphenous Vein ◽

Vein Graft ◽

Saphenous Vein Graft ◽

Artery Bypass ◽

Length Of Hospital Stay ◽

Primary Patency ◽

Secondary Patency ◽

Graft Occlusion ◽

Tibial Artery

Introduction Heparin-bonded expanded polytetrafluoroethylene grafts (Propaten, WL Gore, Flagstaff, AZ, USA) have been shown to have superior patency compared to standard prosthetic grafts in leg bypass. This study analyzed the outcomes of Propaten grafts with distal anastomotic patch versus autogenous saphenous vein grafts in tibial artery bypass. Methods A retrospective analysis of prospective collected data was performed during a recent 15-year period. Sixty-two Propaten bypass grafts with distal anastomotic patch (Propaten group) were compared with 46 saphenous vein graft (vein group). Pertinent clinical variables including graft patency and limb salvage were analyzed. Results Both groups had similar clinical risk factors, bypass indications, and target vessel for tibial artery anastomoses. Decreased trends of operative time (196 ± 34 min vs. 287 ± 65 min, p = 0.07) and length of hospital stay (5.2 ± 2.3 days vs. 7.5 ± 3.6, p = 0.08) were noted in the Propaten group compared to the vein group. Similar primary patency rates were noted at four years between the Propaten and vein groups (85%, 71%, 64%, and 57%, vs. 87%, 78%, 67%, and 61% respectively; p = 0.97). Both groups had comparable secondary patency rates yearly in four years (the Propaten group: 84%, 76%, 74%, and 67%, respectively; the vein group: 88%, 79%, 76%, and 72%, respectively; p = 0.94). The limb salvage rates were equivalent between the Propaten and vein group at four years (84% vs. 92%, p = 0.89). Multivariate analysis showed active tobacco usage and poor run-off score as predictors for graft occlusion. Conclusions Propaten grafts with distal anastomotic patch have similar clinical outcomes compared to the saphenous vein graft in tibial artery bypass. Our data support the use of Propaten graft with distal anastomotic patch as a viable conduit of choice in patients undergoing tibial artery bypass.

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Prosthetic Vascular Graft and Autogenous Vein Graft with Free-Tissue Transfer in Attempted Lower-Limb Salvage

Journal of Reconstructive Microsurgery ◽

10.1055/s-2007-1006508 ◽

1995 ◽

Vol 11 (01) ◽

pp. 31-35

Author(s):

Robert Murphy ◽

Thomas Rojy

Keyword(s):

Limb Salvage ◽

Lower Limb ◽

Vein Graft ◽

Vascular Graft ◽

Free Tissue Transfer ◽

Tissue Transfer ◽

Autogenous Vein

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Arterial Reconstruction after Mangled Extremity: Injury Severity Scoring Systems Are Not Predictive of Limb Salvage

Vascular ◽

10.1258/rsmvasc.13.2.114 ◽

2005 ◽

Vol 13 (2) ◽

pp. 114-119 ◽

Cited By ~ 17

Author(s):

Mohamed Amin Elsharawy

Keyword(s):

Prospective Study ◽

Limb Salvage ◽

Upper Limb ◽

Injury Severity ◽

University Hospital ◽

Secondary Patency ◽

Arterial Reconstruction ◽

Mangled Extremity ◽

Limb Injuries ◽

A Prospective Study

The Vascular Unit at Suez Canal University Hospital in Egypt covers a wide area with high rates of severe injuries. This is a prospective study of mangled extremities to identify risk factors associated with limb loss in these patients. Between December 2000 and August 2003, a prospective study on all patients with arterial injuries in mangled extremities was undertaken. All patients were scored using the Mangled Extremity Severity Score (MESS) and the Mangled Extremity Severity Index (MESI). During this period, arterial reconstruction was performed in 62 patients. Primary patency, secondary patency, and limb salvage rates were 81%, 85.5%, and 93.5%, respectively. The only factor affecting limb salvage (statistical trend) was the site of trauma (upper limb 100% vs lower limb 89%; p = .08%). There was no significant effect related to the mechanism of trauma (blunt 90% vs stab 100%; p = .125), MESS (< 7, 100% vs > 7, 91%; p = .22), and MESI (< 20, 100% vs > 20, 90.5%; p = .154). Upper limb injuries were the least likely to lead to amputation. We recommend that all injuries, whatever their score, should be surgically explored before treatment decisions are made.

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Urgent intraoperative endovascular stent placement to resolve acute hepatic or portal venous obstruction during liver surgery: a case series

Surgical Case Reports ◽

10.1186/s40792-020-01093-4 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Yutaro Kato ◽

Atsushi Sugioka ◽

Masayuki Kojima ◽

Junichi Yoshikawa ◽

Yoshinao Tanahashi ◽

...

Keyword(s):

Hepatic Vein ◽

Liver Surgery ◽

Vein Graft ◽

Case Series ◽

Endovascular Stents ◽

Ischemic Time ◽

Efficient Treatment ◽

Surgical Interventions ◽

Anterior Section ◽

Graft Interposition

Abstract Background Acute obstruction of the hepatic vein (HV) or the portal vein (PV), particularly when it occurs during liver surgery, is potentially fatal unless repaired swiftly. As surgical interventions for this problem are technically demanding and potentially unsuccessful, other treatment options are needed. Case presentation We report two cases of acute, surgically uncorrectable HV or PV obstruction during liver resection or living donor liver transplantation (LDLT), which was successfully treated with urgent intraoperative placement of endovascular stents using interventional radiology (IVR). In Case 1, a patient with colonic liver metastases underwent a non-anatomic partial hepatectomy of the segments 4 and 8 with middle hepatic vein (MHV) resection. Additionally, the patient underwent an extended right posterior sectionectomy with right hepatic vein (RHV) resection for tumors involving RHV. Reconstruction of the MHV was needed to avoid HV congestion of the anterior section of the liver. The MHV was firstly reconstructed by an end-to-end anastomosis between the MHV and RHV resected stumps. However, the reconstruction failed to retain the HV outflow and the anterior section became congested. Serial trials of surgical revisions including re-anastomosis, vein graft interposition and vein graft patch-plasty on the anastomotic wall failed to recover the HV outflow. In Case 2, a pediatric patient with biliary atresia underwent an LDLT and developed an intractable PV obstruction during surgery. Re-anastomosis with vein graft interposition failed to restore the PV flow and elongated warm ischemic time became critical. In both cases, the misalignment in HV or PV reconstruction was likely to have caused flow obstruction, and various types of surgical interventions failed to recover the venous flow. In both cases, an urgent IVR-directed placement of self-expandable metallic stents (SEMS) restored the HV or PV perfusion quickly and effectively, and saved the patients from developing critical conditions. Furthermore, in Cases 1 and 2, the SEMS placed were patent for a sufficient period of time (32 and 44 months, respectively). Conclusions The IVR-directed, urgent, intraoperative endovascular stenting is a safe and efficient treatment tool that serves to resolve the potentially fatal acute HV or PV obstruction that occurs in the middle of liver surgery.

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Digital Arterial Occlusion in Scleroderma: Is There a Role for Digital Arterial Reconstruction?

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.2000.0439 ◽

2000 ◽

Vol 25 (6) ◽

pp. 611-613 ◽

Cited By ~ 17

Author(s):

M. M. TOMAINO

Keyword(s):

Vein Graft ◽

Raynaud’S Phenomenon ◽

Arterial Occlusion ◽

Interphalangeal Joint ◽

Digital Artery ◽

Arterial Reconstruction ◽

Distal Interphalangeal Joint ◽

Palmar Arch ◽

Distal Interphalangeal ◽

Artery Reconstruction

A 47-year-old patient with Raynaud’s phenomenon secondary to scleroderma developed long finger ischaemic pain. This was successfully treated with a palmar sympathectomy and a long finger digital artery reconstruction using a reversed small calibre vein graft between a perforator from the deep palmar arch and the radial digital artery at the level of the distal interphalangeal joint.

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Autogenous Vein Graft for Repair of Acute Tibial Artery Injury

Annals of Surgery ◽

10.1097/00000658-196508000-00007 ◽

1965 ◽

Vol 162 (2) ◽

pp. 218-220 ◽

Cited By ~ 6

Author(s):

James A. OʼNeill ◽

Duxcan A. Killen

Keyword(s):

Vein Graft ◽

Artery Injury ◽

Tibial Artery ◽

Autogenous Vein

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Traumatic Aneurysm of the Extracranial Vertebral Artery

Neurosurgery ◽

10.1227/00006123-198610000-00021 ◽

1986 ◽

Vol 19 (4) ◽

pp. 628-630 ◽

Cited By ~ 19

Author(s):

Abolfazl Rahimizadeh ◽

Manouchehr Sabouri-Daylami ◽

Naser Amir-Moezi ◽

Karim Haddadian

Keyword(s):

Carotid Artery ◽

Vertebral Artery ◽

Vein Graft ◽

Posterior Approach ◽

Traumatic Aneurysm ◽

Bony Canal ◽

Carotid Artery Reconstruction ◽

Autogenous Vein ◽

Extracranial Vertebral Artery ◽

Artery Reconstruction

Abstract Aneurysms of the extracranial vertebral artery are rare because of the protection afforded by the bony canal, and the literature contains only a few limited reports on this subject. In the view of its rarity, we present the case of a 20-year-old soldier with a traumatic aneurysm of the vertebral artery at the C-2 level. Because of occlusion of the ipsilateral carotid artery, reconstruction of the vertebral artery by autogenous vein graft was undertaken through a posterior approach; because of inadequate mobilization of the artery, continuity was preserved using aneurysmorrhaphy. The literature is reviewed, and the various treatments are discussed.

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