Autologous Vein Research Articles

Reconstruction of parotid duct defect with autologous vein graft and vascular coupler after buccal mucosa cancer resection

The distal end of parotid duct is often inevitably resected en-block with the buccal mucosa cancer to obtain safety margin and prevent local recurrence. Ligation of duct frequently causes complications like cheek swelling, fistula and gland function loss. The authors describe a novel procedure of combined use of autologous vein graft and vascular coupler to reconstruct the parotid duct defect for buccal mucosa cancer patients who undergo radical neck dissection and free-flap reconstruction, no lumen-stent or cannula is needed. Case examples are shown to illustrate the operative details and different outcomes for two kinds of orifice site choices. Key factors for success include the proper use of Coupler device, right choice of new orifice location and maintenance of lumen patency. For buccal mucosa cancer patients, this novel method for parotid duct reconstruction could effectively reduce postoperative complications and preserve the parotid gland function.

Anatomical Study of the Descending Branch of the Lateral Femoral Circumflex Artery and Veins in Vascular Grafting in Japanese Cadavers.

Background:In microsurgery development, autologous vein grafting is necessary when there are no suitable blood vessels for anastomosis around the flap recipient site or when the vascular pedicle of the flap is short. The descending branches of the lateral femoral circumflex artery (LFCA) and vein have been used as a vascular bundle instead of vein grafts, but to our knowledge, there have been no reports on the relationship between thigh length and vessel length. In this study, we performed a macroscopic examination of the LFCA descending branch length required for grafting.Methods:The length of the LFCA descending branches and veins as well as thigh length were measured in 16 preserved cadaveric legs.Results:The average length of the thigh was 42.6 cm. It was possible to harvest a mean length of 14.2 cm of the descending branches of the lateral femoral circumflex vessels. Descending branches of the LFCA and veins were identified in all cases. It was estimated that the length of the LFCA descending branch and veins could be collected in 20% of the thigh length in 98% of cases.Conclusion:When preparing a preoperative plan, it is important to thoroughly consider the required length of blood vessels for grafting and whether it is possible to harvest vessels with sufficient length.

Reliability of the Mangled Extremity Severity Score in the Management of Peripheral Vascular Injuries in Children: A Retrospective Review.

This study was aimed to evaluate different management modalities for peripheral vascular trauma in children, with the aid of the Mangled Extremity Severity Score (MESS). A single-center retrospective analysis took place between 2010 and 2017 at University Hospitals, having emergencies and critical care centers. Different types of vascular repair were adopted by skillful vascular experts and highly trained pediatric surgeons. Patients were divided into three different age groups. Group I included those children between 5 and 10 years; group II involved pediatrics between 11 and 15 years; while children between 16 and 21 years participated in group III. We recruited 183 children with peripheral vascular injuries. They were 87% males and 13% females, with the mean age of 14.72 ± 04. Arteriorrhaphy was performed in 32%; end-to-end anastomosis and natural vein graft were adopted in 18% and 29% respectively. On the other hand, 20% underwent bypass surgery. The age groups I and II are highly susceptible to penetrating trauma ( p = 0.001), while patients with an extreme age (i.e., group III) are more susceptible to blunt injury ( p = 0.001). The MESS has a significant correlation to both age groups I and II ( p = 0.001). Vein patch angioplasty and end-to-end primary repair should be adopted as the main treatment options for the repair of extremity vascular injuries in children. Moreover, other treatment modalities, such as repair with autologous vein graft/bypass surgery, may be adopted whenever possible. They are cost-effective, reliable, and simple techniques with fewer postoperative complication, especially in poor/limited resources.

Postoperative results, pathologic outcome, and long-term patency rate of autologous vein reconstruction of the mesentericoportal axis after pancreatectomy.

In advanced pancreatic cancer (PC), en-bloc vein resection and reconstruction (VR) is a curative option in oncologic pancreatectomy. However, few data about long-term patency rates after autologous venous reconstruction are available. We aimed to analyze whether early postoperative morbidity is increased by additional VR. Furthermore, pathologic outcomes and long-term patency rates after applying autologous vein material are examined. Data on patients who underwent surgical resection for suspicious malignancy were collected prospectively. Early postoperative complications, as well as the circumferential resection margins were analyzed retrospectively. Patients with VR (VR+) were compared with patients without vein resection (VR-). Vein reconstruction was always performed by autologous vein replacement, followed by a 6-month application of Enoxaparin. Patency rates of the mesenteric vessels in long-term follow-up exams were determined by contrast-enhanced computed tomography (CT) every 3months. Two hundred nineteen pancreatic resections for suspicious malignancy were performed. In 82 patients, VR occurred (37.4%). No significant differences between VR+ and VR- were observed concerning 30-day mortality and postoperative morbidity. R0 rate did not differ between the two groups. By applying autologous vein material, the average patency rate was 90%. In terms of tumor free resection margins, equal oncologic results can be achieved by additional vein resection. Because the patency rate is high in follow-up, and early postoperative complication rates are not increased in patients with VR+, vein resection and reconstruction should be performed if oncologically necessary. The application of autologous vein reconstruction followed by a 6-month enoxaparin treatment seems to yield favorable technical results.

Comparing Outcomes of Grafts Used in Peyronie’s Disease Surgery: a Systematic Review

Peyronie’s disease (PD) is a scarring condition of the tunica albuginea. Various graft materials are used to fill defects following plaque incision (PIG) or partial excision (PEG), but the optimal graft material remains unknown. This systematic review compares outcomes of different grafts, performed with or without concurrent penile prosthesis implantation (PPI). Studies reported quantitative curvature assessment, with adequate follow-up to assess straightening, change in penile length, postoperative erectile dysfunction (ED), and patient satisfaction. From a total of 41 study arms, 1732 patients underwent PEG/PIG without and 302 with PPI. For PIG/PEG without PPI, the most frequently used grafts are cadaveric human pericardium (38.3%), autologous saphenous vein (21.2%), and porcine small intestinal submucosa (13.5%) with reported mean preoperative curvature of 69.3° and curvature recurrence ≥ 30° in 6.6%, 5.4%, and 15.4%, respectively. Grafts used most commonly with PPI include hemostatic patches (36.4%), bovine pericardium (34.8%), with similar mean preoperative curvature of 70.0° (p < 0.01). Satisfaction rates for PIG/PEG without PPI ranged from 70 to 100% with lowest satisfaction rates associated with dermis (70%) and human pericardium (73.4%). In the prosthesis cohort, satisfaction rates exceeded 88% with all grafts. Human pericardium seems to be the most commonly used graft when PPI is not indicated, with low rates of curvature recurrence, an acceptable rate of ED and satisfaction. Hemostatic patches are the most favorable graft choice with concurrent PPI. In general, the PD treatment literature is limited to low evidence grade retrospective studies, and further prospective investigation is warranted.

Reconstruction of Tendon Sheath by a Vein Graft in Flexor Tendon Repair in Adjacent Digits

Background: Adhesion formation after tendon injury isa challenging clinical problem.Aim: We compare the outcome of reconstructing the flexortendon sheath after primary flexor tendon repair using anautogenous vein graft to reduce post-operative peritendiniousadhesions.Methods: Eight patients have acute flexor tendon injuriesof both FDS and FDP in zone II in more than one digit.Primary tenorrhaphy was done using traditional technique.In one-digit vein graft was used to reconstruct tendon sheathwindow, while in the other digit, the tendon sheath leftuntreated. Post-operative physiotherapy program of controlledactive motion is used for both group. All patients were assessedusing the second Buck-Gramcko scale at 2 and 6 months.Results: For the vein graft group, 2 patient had excellentresult, 2 had very good, and 4 patients had good result. Ingroup II, 2 patients had very good result, 2 patients had goodresult, and 4 patients had fair result.Conclusion: The use of autologous vein graft as a substituteof tendon sheath is a good treatment modality. Compared toconventional tendon repair technique, it was associated withless adhesion formation and less joint contracture.Evidence Based Medicine: Level IV, vase series.

Mesoportal bypass, interposition graft, and mesocaval shunt: Surgical strategies to overcome superior mesenteric vein involvement in pancreatic cancer

BackgroundIn pancreatic cancer, extensive tumor involvement of the mesenteric venous system poses formidable challenges to operative resection. Such involvement can result from cavernous collateral veins leading to increased intraoperative blood loss or long-segment vascular defects of not only just the superior mesenteric vein but also even jejunal/ileal branches. Strategies to facilitate margin-free resection and safe vascular reconstruction in pancreatic surgery are important, particularly because systemic control of the tumor is improving with multi-agent chemotherapy regimens. MethodsWe describe a systematic, multidisciplinary assessment for patients with pancreatic cancer that involves the superior mesenteric vein, as well as the preoperative planning of those undergoing operative resection. In addition, detailed descriptions of operative approaches and technical strategies, which evolved with increasing experience at a high-volume center, are presented. ResultsFor the preoperative evaluation of tumor-free, vascular locations for potential reconstruction and collateralization, computed tomographic imaging with high-resolution of vascular structures (used with 3-dimensional or cinematic rendering) allows a precise calibration of radiographic data with intraoperative findings. From an operative perspective, we identified 5 potential strategies to consider for resection: collateral preservation, mesoportal bypass (preresection), mesoportal interposition graft (postresection), mesocaval shunt, and various combinations of these strategies. Many of these techniques use interposition grafts, making it essential to assess autologous veins (preferred conduit for reconstruction) or to prepare cryopreserved vascular allografts (an alternative conduit, which must be thawed and should be matched for size and blood type). ConclusionHerein we share operative strategies to overcome involvement of the superior mesenteric vein in pancreatic cancer. Improvements in preoperative planning and operative technique can address common barriers to resection with curative intent.

Tissue-engineered vessel derived from human fibroblasts with an electrospun scaffold.

Advanced cardiovascular disease often requires surgical revascularization for small diameter arterial bypass procedures, and there is a need for alternative grafts in those patients lacking autologous vein. A decellularized biological vessel with the characteristics of a small artery and the ability to remodel in vivo could replace currently available bypass grafts. In this study, a biodegradable electrospun scaffold was specifically designed to be placed in a biomimetic perfusion system to generate a tissue-engineered vessel from human dermal fibroblasts. The polyglycolic acid electrospun scaffold was co-electrosprayed with a sacrificial porogen microparticle, polyethylene oxide, to increase porosity and pore size. After a 10-week culture period in the biomimetic system, the tissue-engineered vessel derived from human fibroblasts was further processed with decellularization to form an allogeneic tissue-engineered vessel. The tissue-engineered vessel had a similar morphology by histological staining for collagen and elastin before and after decellularization. The mechanical properties (burst pressure, ultimate tensile strength, and elastic modulus) remained stable after decellularization and were on the same magnitude as a human saphenous vein. The decellularization processing demonstrated no loss of collagen, near complete removal of DNA, and no presence of intracellular proteins. The decellularized tissue-engineered vessel supported the growth of endothelial cells on the surface, and fibroblasts were able to migrate into the midportion of the matrix. Therefore, an electrospun scaffold provides a versatile biomaterial to create a decellularized tissue-engineered vessel derived from human dermal fibroblasts with morphological and mechanical properties for use as a small diameter vascular graft.

THE IMPACT OF MIDDLE HEPATIC VEIN RECONSTRUCTION IN RIGHT LOBE LIVING DONOR LIVER TRANSPLANTATION, ANALYSIS OF CONGESTION AREA OF ANTERIOR SECTION AND PORTAL VEIN FLOW VOLUME

Introduction: Middle hepatic vein (MHV) reconstruction in right lobe is reported to contribute better outcome. Large congestion of anterior section in right lobe graft can be a potential cause of small for size syndrome (SFSS), and releasing this congestion with MHV reconstruction would improve the outcome. Another cause of SFSS is high flow volume of portal vein. Portal vein flow volume (PVFV) over 300 ml/min/100g graft weight (GW) was reported as a cause of SFSS. We report how the MHV reconstruction in right lobe graft contribute to better outcome by analyzing congestion area and portal vein flow volume. Material and method: From February 2017 to December 2018, we had 268 right lobe living donor liver transplantation with MHV reconstruction. MHV was reconstructed with autologous portal vein and consecutive umbilical vein. We classified patients into 4 groups according to PVFV per 100g graft weight, and congestion area ratio (CAR). Group 1 is PFFV < 300ml/m/100g GW, and CAR < 40%, including 83 patients. Group 2 is PF > 300ml/m/100g, and CAR > 40%, including 76 patients. Group 3 is PF < 300ml/m/100g, and CAR < 40%, including 63 patients. Group 4 is PF <300ml/m/100g, and CR <40%, and including 46 patients.As for Small for size syndrome (SFSS), group 1 is considered as low risk, group 2 and 3 are considered as medium risk, and group 4 patients are considered as high risk. We compared patients background, intraoperative data, and postoperative outcome (postoperative complications, SFSS, and survival) among these 4 groups. Results: There was no significant difference in preoperative status among 4 groups. Except for congestion area and portal flow volume, there was no significant difference in intraoperative data. There was no significant difference in postoperative complications, incidence of SFSS. The 2 year survival of each group showed no significant difference among 4 groups.Conclusion: The outcome of medium and high risk groups was equivalent to low risk group. MHV reconstruction release the congestion of anterior section and it also makes tolerate the high portal flow. These factors is considered to make the outcome of medium and high risk group comparable to that of low risk group, and finally the outcome of right lobe living donor liver transplantation result in better outcome.

Meso - Rex shunt using the inferior mesenteric vein in a paediatric patient

Abstract Extrahepatic portal vein obstruction primarily results from congenital vascular malformations or acquired portal venous thrombosis. Portal hypertension can lead to various complications such as recurrent upper gastrointestinal hemorrhage secondary to varices, ascites, hypersplenism, or encephalopathy. Meso-rex shunt is a curative surgical procedure that uses autologous vein graft as a bypass to redirect blood from the superior mesenteric vein (SMV) to the patent intrahepatic left portal vein in patients. The most common vein graft used is internal jugular vein (IJV) harvested from the patient's neck. Meso-Rex shunt using the inferior mesenteric vein (IMV) has been rarely described in the literature. It avoids neck dissection and its associated complications. It also reduces the number of anastomoses down to one. We report a 14-year-old girl who underwent a successful meso-Rex shunt using the IMV and summarize the literature.

A novel tissue engineered nerve graft constructed with autologous vein and nerve microtissue repairs a long-segment sciatic nerve defect.

Veins are easy to obtain, have low immunogenicity, and induce a relatively weak inflammatory response. Therefore, veins have the potential to be used as conduits for nerve regeneration. However, because of the presence of venous valves and the great elasticity of the venous wall, the vein is not conducive to nerve regeneration. In this study, a novel tissue engineered nerve graft was constructed by combining normal dissected nerve microtissue with an autologous vein graft for repairing 10-mm peripheral nerve defects in rats. Compared with rats given the vein graft alone, rats given the tissue engineered nerve graft had an improved sciatic static index, and a higher amplitude and shorter latency of compound muscle action potentials. Furthermore, rats implanted with the microtissue graft had a higher density and thickness of myelinated nerve fibers and reduced gastrocnemius muscle atrophy compared with rats implanted with the vein alone. However, the tissue engineered nerve graft had a lower ability to repair the defect than autogenous nerve transplantation. In summary, although the tissue engineered nerve graft constructed with autologous vein and nerve microtissue is not as effective as autologous nerve transplantation for repairing long-segment sciatic nerve defects, it may nonetheless have therapeutic potential for the clinical repair of long sciatic nerve defects. This study was approved by the Experimental Animal Ethics Committee of Chinese PLA General Hospital (approval No. 2016-x9-07) on September 7, 2016.

The safety of bovine tissue arterial repair in removal of infected prosthetic hemodialysis grafts.

More than 400,000 Americans require dialysis, and many receive it via a prosthetic arteriovenous graft. Infection of these grafts is rare, but associated with significant morbidity and mortality. The gold standard is total graft excision with arteriotomy closure. This was previously done with autologous vein, but bovine tissue offers a reasonable alternative. The objective of this article is to evaluate a community hospital experience with bovine tissue arterial repair after total graft excision of infected prosthetic arteriovenous graft. A retrospective review was performed of all cases of infected prosthetic arteriovenous graft removal with bovine tissue arterial repair was performed. Thirteen cases were identified. Presentation, location of graft, and causative organism were reviewed; outcomes including reoperation and mortality were recorded. Of the 13 patients, 12 (92%) had positive cultures of the graft, bloodstream, or wound. Methicillin-resistant Staphylococcus aureus was the most commonly isolated organism (54%). There were two unplanned reoperations including hematoma drainage and wound debridement within the first year. Over the 1-year follow-up period, 1 patient died for a mortality of 8%. There were no re-infections during follow-up. Prosthetic arteriovenous graft infection remains a difficult challenge and is associated with significant morbidity and mortality. It presents in a variety of ways, including within an old thrombosed graft. Over the last several years, the causative organism has increasingly become drug resistant. Treatment with total graft excision requires arteriotomy closure, and for this bovine tissue has been demonstrated to be a viable option.

Alternative Venous Conduits for Below Knee Bypass in the Absence of Ipsilateral Great Saphenous Vein

Vein is regarded superior to artificial graft in peripheral arterial bypass surgery. However, this option is often limited owing to previous use or removal of the ipsilateral greater saphenous vein (iGSV). In this case, the contralateral great saphenous vein (cGSV), the small saphenous vein (SSV), or arm veins (AV) are possible alternatives. Experience with all three grafts for below knee vein bypass is reported. Consecutive patients treated at an academic tertiary referral centre between January 1998 and July 2018 using the cGSV, SSV, or AV as the main peripheral bypass graft were analysed. Study end points were primary patency, secondary patency, limb salvage, and survival. Over the observed time period, 2642 bypass operations for treatment of peripheral artery disease with below knee target arteries were performed at the authors' institution: 1937 procedures using the iGSV; 644 bypass procedures using the cGSV (n=186; 28.9%), SSV (n=101; 15.7%), or AV (n=357; 55.4%); and 61 procedures using a prosthetic graft. The median follow up period was 2.3 years (range 9 days-18.5 years). Thirty day mortality was 1.9% for the whole group and similar between the three groups. After five years, primary and secondary patency rates were comparable between the three groups. Secondary patency was 75% (95% confidence interval [CI] 66-83) in the cGSV and SSV groups, and 65% (95% CI 57-73) in the AV group (p=.47). Limb salvage and survival after five years were, respectively, 73% (95% CI 65-81) and 89% (95% CI 82-95) in the cGSV group, 79% (95% CI 69-89) and 87% (95% CI 79-95) in the SSV group, and 74% (95% CI 68-80) and 83% (77-89) in the AV group (p=.46). All three types of alternative autologous vein graft are equal regarding outcome parameters. Vascular surgeons should consider all autologous options if their preferred choice is not available.

Facial Nerve Repair by Muscle-Vein Conduit in Rats: Functional Recovery and Muscle Reinnervation.

The facial nerve is the most frequently damaged nerve in head and neck traumata. Repair of interrupted nerves is generally reinforced by fine microsurgical techniques; nevertheless, regaining all functions is the exception rather than the rule. The so-called "postparalytic syndrome," which includes synkinesia and altered blink reflexes, follows nerve injury. The purpose of this study was to examine if nerve-gap repair using an autologous vein filled with skeletal muscle would improve axonal regeneration, reduce neuromuscular junction polyinnervation, and improve the recovery of whisking in rats with transected and sutured right buccal branches of the facial nerve. Vibrissal motor performance was studied with the use of a video motion analysis. Immunofluorescence was used to visualize and analyze target muscle reinnervation. The results taken together indicate a positive effect of muscle-vein-combined conduit (MVCC) on the improvement of the whisking function after reparation of the facial nerve in rats. The findings support the recent suggestion that a venal graft with implantation of a trophic source, such as autologous denervated skeletal muscle, may promote the monoinnervation degree and ameliorate coordinated function of the corresponding muscles.

Impact of Angiosome Targeted Femorodistal Bypass Surgery on Healing Rate and Outcome in Chronic Limb Threatening Ischaemia

In the presence of long lesions, in patients with chronic limb threatening ischaemia, a femorodistal bypass is often the only option to avoid major amputation. This study investigated whether targeted bypass to the affected angiosome, according to the angiosome concept definition of direct (DR) and indirect revascularisation (IR), has an impact on wound healing, major amputation rate, and mortality. A retrospective analysis was performed at Ghent University Hospital of 201 non-healing ischaemic wounds (Rutherford categories 5 and 6) requiring femorodistal bypass surgery in 177 patients (61% male, median age 69 years) with a follow up of 36 months. For every patient, the site of the ulcer, the type of bypass, and material were identified. Based on ulcer location and distal anastomosis, the legs were divided into DR and IR. Kaplan–Meier univariable analysis was used to estimate cumulative ulcer healing, leg salvage, survival, and patency. DR was performed in 103 legs (51%) and IR in 98 legs (49%), with no difference in comorbidity. The mean wound healing time was seven months. DR did not lead to a higher healing rate. The fastest healing rate was obtained when opting for a DR with an autologous greater saphenous vein (GSV; 90% at 12 months). Cryopreserved allografts also yielded good results, especially for wound healing after IR (85% at 12 months). Major amputation was performed in 28.5% after IR vs. 17.3% after DR (p = .071). There was no difference in mortality rate (36.8% [DR] vs. 41.3% [IR]) (p = .088). Autologous GSV had a longer primary patency, primary assisted patency, and secondary patency (26, 34, and 38 months, respectively) than cryopreserved GSV (12.5, 18, and 24 months, respectively) (p = .002, p = .003, and p = .018, respectively), with no difference between DR and IR. Direct or indirect revascularisation performed according to the angiosome concept definition yields similar results with regard to healing rates, limb salvage, and mortality.

The Anti-Inflammatory Effects of Anacardic Acid on a TNF-α - Induced Human Saphenous Vein Endothelial Cell Culture Model.

Coronary bypass operations are commonly performed for the treatment of ischemic heart diseases. Coronary artery bypass surgery with autologous human saphenous vein maintains its importance as a commonly used therapy for advanced atherosclerosis. Vascular inflammation-related intimal hyperplasia and atherosclerotic progress have major roles in the pathogenesis of saphenous vein graft disease. In our study, we investigated the effect of anacardic acid (AA), which is a bioactive phytochemical in the shell of Anacardium occidentale, on atherosclerosis considering its inhibitory effect on NF-κB. We observed relative ICAM-1 and NF-κB mRNA levels by qRT-PCR method in a TNF-α- induced inflammation model of saphenous vein endothelial cell culture after 0.1, 0.5, 1 and 5 μM of AA were applied to the cells. In addition, protein levels of ICAM-1 and NF-κB were evaluated by immunofluorescent staining. The results were compared between different concentrations of AA, and also with the control group. It was found that 5 μM, 1 μM and 0.5 μM of AA had toxic effects, while cytotoxicity decreased when 0.1 μM of AA was applied both alone and with TNF-α. When AA was applied with TNF-α, there was a decrease and suppression in NF-κB expression compared with the TNF-α group. TNF-α-induced ICAM-1 expression was significantly reduced more in the AA-applied group than in the TNF-α group. In accordance with our results, it can be said that AA has a protective role in the pathogenesis of atherosclerosis and hence in saphenous vein graft disease.

Arm Vein versus Small Saphenous Vein for Lower Extremity Bypass in the Absence of Both Great Saphenous Veins

Bypass surgery remains the gold standard for long and complex arterial occlusions in the lower limb. The vein is regarded superior to prosthetic conduits in peripheral arterial bypass surgery. However, this option is often limited because of previous bypass, stripping, or poor quality of the ipsilateral and/or contralateral great saphenous vein (GSV). Under these circumstances, the arm vein (AV) and small saphenous vein (SSV) are the only alternative autologous vein grafts. We analyzed all consecutive patients treated at an academic tertiary referral center between January 1998 and July 2018 using either the AV or SSV as the main peripheral bypass graft. Study end points were primary patency, secondary patency, limb salvage, and survival. In total, 416 bypass procedures using exclusively AV (n=327) or SSV (n=89) were performed. There was a predominance of male gender. The majority of risk factors were evenly distributed between groups. The mean follow-up period was 2.3years (0.9 to 13.3years). Five-year primary and secondary patency rates were 39% (95% CI: 31-47%) and 67% (59-75%) for AV and 53% (41-66%) and 76% (67-86%) for SSV, respectively (P=0.2 and 0.25). The five-year limb salvage and survival rates were 71% (68-81%) and 84% (77-90%) for AV and 78% (67-88%) and 90% (82-98%) for SSV, respectively (P=0.52 and 0.11). Both AV and SSV are equally effective alternatives for peripheral bypass if no GSV is available. Although there was a trend toward better results with the SSV, there was no significant difference between the 2 options.

Current results of arterial injuries seen at femoral and popliteal arteries in civil society

Background: Lower extremity arterial injuries caused by penetrating or fired-gun trauma may result in limb or loss of life. Early intervention has critical importance. The aim of this study was to investigate the importance of early intervention and outcomes.Methods: We retrospectively reviewed the data on 144 patients (18 females, 126 males) who were treated in Istanbul Medipol University Hospital between January 2016 to 2018. All patients had an arterial injury at level of femoral and popliteal arteries. Standard statistical methods were used for data analysis.Results: Revascularization was performed to all 144 (18 females, 126 males) patients. Autologous saphenous vein graft interposition was performed in 96 patients. End-to-end repair was performed in 39 patients. 9 patients underwent a polytetrafluoroethylene graft (8 mm ringed) interposition.Conclusions: All viable limbs should be revascularized rapidly. The primary goal is to provide bleeding control rapidly and to prevent the prolongation of ischemic time. It should be kept in mind that in addition to surgical technique, fasciotomy may be required in arterial injuries with ischemic time of more than 6-8 hours.

Outcomes of Upper Extremity Arterial Bypass for Trauma

Trauma remains a leading cause of morbidity and mortality worldwide. Vascular injuries are present in roughly 1% to 2% of trauma patients, with the majority of injuries occurring to the extremities. This study aimed to determine predictors of poor outcomes in upper extremity bypasses performed for traumatic arterial injury. All patients admitted between November 2002 and October 2017 who underwent upper extremity arterial bypass for trauma at a single level 1 trauma center were included for analysis. The primary outcome was a composite of revision for bleeding or thrombosis, arm amputation or perioperative death. Data were analyzed by frequency and contingency table analysis with Kaplan-Meier methods used for survival analysis. During the study period, 31 patients presented with upper extremity arterial injuries and underwent arterial bypass. The mean age was 27.2 ± 13.5 years (median, 25 years); 80.6% were male. The mechanism of injury was penetrating in 20 of 31 (64.5%) with the remaining having a blunt mechanism. Specialty performing the bypass was Vascular surgery in 22 of 31 (71%), with the remainder by trauma, plastics or pediatric surgery. Autologous vein was used in 30 of 31 (96.8%). No significant predictors of poor outcome were noted including penetrating versus blunt mechanism (P = .18), specialty performing bypass (P = .98), interposition bypass (P = .64), associated orthopedic injury (P = .35), Injury Severity Score (P = .31), or conduit type (P = .34) (Table). The composite outcome was reached in only 7 of 31 patients. Follow-up demonstrates 90% survival at 20 months (Figs 1 and 2). Upper extremity bypass for traumatic arterial injury has a low composite end point. While this may be an effect of sample size, it appears that these patients do well overall. These data may be useful for sample size calculations studies.TableCharacteristics of patients undergoing upper extremity bypass for trauma Open table in a new tab

Contemporary Results of In Situ Versus Reversed Autologous Saphenous Vein Infrainguinal Bypass for the Management of Lower Extremity Arterial Disease

The objective was to retrospectively assess early and long-term results in patients undergoing infrainguinal vein bypass for peripheral artery obstructive disease (PAOD) using either in situ or reversed grafts in a single-center experience.