Josef Klocker, Andreas Bertoldi, Bernhard Benda, Lukas Pellegrini, Olaf Gorny, Gustav Fraedrich
Vascular Surgery, Medical University Innsbruck, Innsbruck, Austria.
OBJECTIVES: To report on outcome after vein graft interposition in patients with upper and lower limb arterial injuries.
METHODS: Retrospective data analysis. All patients who underwent vein graft interposition for repair of limb arterial injuries in our institution since 1989 were included, analyzed and followed. Study endpoints were: perioperative mortality, early and long-term limb salvage, patency and vascular re-intervention.
RESULTS: A total of 152 patients (127 male; median age: 31.7 years; range: 5.3-77.2) who presented with 158 lesions of limb arteries (lower limb: n=90; upper limb: n=68) underwent repair using vein graft interposition. The vast majority of lesions were caused by blunt trauma (n=144; 91%).
Early results: 30-day mortality was 3.3%. Limb loss rate was significantly lower in the upper (n=2; 2.9%) than the lower limb (n=12; 13.3%; p<0.05). Primary patency was 93% (upper limb) and 89% (lower limb): early graft occlusions occurred both in the upper (n=5; 7%) and the lower limb (n=10; 11%; p=0.59). Occlusions were followed by amputation in 8 cases (upper limb: 1 of 5; lower limb: 7 of 10) despite successful revision of the occluded grafts.
Long-term results after a median follow-up period of 6 years (range: 0.3-23.4): upper limb (68% of patients were followed): no late limb loss, no vascular re-intervention, patency: 97%; lower limb (66% of patients were followed): one late limb loss, one re-do bypass for vein graft dilation, patency: 98%.
CONCLUSIONS: Repair of arterial injuries in the limbs using vein grafts is hampered by a considerable risk of early occlusion, probably caused by insufficient anticoagulation and due to associated injuries. Early graft occlusion is frequently followed by limb loss, especially in the lower limb. However, during long-term follow-up, occlusions of interposed vein grafts, and vascular re-interventions as well as late amputations are uncommon.
AUTHOR DISCLOSURES: B. Benda: Nothing to disclose; A. Bertoldi: Nothing to disclose; G. Fraedrich: Nothing to disclose; O. Gorny: Nothing to disclose; J. Klocker: Nothing to disclose; L. Pellegrini: Nothing to disclose.
Posted April 2013