title: Extra-anatomic bypass of failed traumatic arterial repairs.
abstract: Arterial injuries are best treated by primary repair or anatomically placed interposition grafts. Occasionally, these repairs fail due to adverse local factors, such as soft-tissue infection or enteric contamination. In these instances, limb salvage may require extra-anatomic arterial reconstruction. Between 1979 and 1989, 13 extra-anatomic bypasses were performed in ten male patients following nine failed primary repairs and one ligation of a traumatic arterial injury. The sites of arterial injury were: aorta (two), iliac (five), femoral (two), popliteal (one). Enteric contamination was present at initial operation in six patients; the remaining four had sustained massive soft-tissue injury. Reoperation was required for hemorrhage (seven), pseudoaneurysm (two), and arteriovenous fistula (one). All patients had developed local wound problems that militated against another anatomic repair. Extra-anatomic bypasses performed were: axillo-femoral (three), femoro-femoral (four), obturator (one), and two extra-anatomic femoral to popliteal saphenous vein grafts routed around an infected field. A second extra-anatomic reconstruction was performed for recurrent hemorrhage in three patients, (axillo-femoral--two, obturator--one). One patient with a neuropathic extremity and a functioning graft underwent amputation at 2 months following the initial injury. Two patients died of systemic sepsis. Seven patients (70%) have functional extremities with intact pulses at 2 to 24 months post bypass (mean, 7 months). Limb salvage after secondary disruption of secondarily infected arterial repairs can be achieved by appropriate extra-anatomic arterial reconstruction. In such cases, limb loss is due to soft-tissue sepsis or neuro-skeletal injuries and not vascular insufficiency.
authors.affiliation: University of Southern California School of Medicine, Los Angeles.
authors.forename: S C
authors.initials: SC
authors.lastname: Stain
authors.forename: F A
authors.initials: FA
authors.lastname: Weaver
authors.forename: A E
authors.initials: AE
authors.lastname: Yellin
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D001011:Aorta / Q000293:injuries / Q000601:surgery; D001158:Arteries / Q000293:injuries* / Q000601:surgery; D001424:Bacterial Infections / Q000150:complications / Q000601:surgery; D001807:Blood Vessel Prosthesis; D005263:Femoral Artery / Q000293:injuries / Q000601:surgery; D006801:Humans; D007083:Iliac Artery / Q000293:injuries / Q000601:surgery; D008026:Ligation; D008297:Male; D011150:Popliteal Artery / Q000293:injuries / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D018805:Sepsis / Q000209:etiology