Limb trauma with arterial injury: long-term performance of venous interposition grafts.
BACKGROUND
In contrast to arterial occlusive disease, data on long-term outcomes after vein grafts in limb trauma with arterial injury are sparse.


METHODS
From 1991 through 2001, 22 trauma victims received 23 interposition vein grafts performed by an interdisciplinary team of trauma and vascular surgeons. Indications included both blunt and penetrating injuries with critical limb ischemia in the majority of cases.


RESULTS
Operative treatment of the injured vessels (brachial n = 5, radial/ulnar n = 7, popliteal n = 6, tibial n = 3, pedal n = 2) encompassed venous interposition graft of either saphenous (n = 15) or cephalic vein (n = 8). All patients survived the operative procedure. 4 graft occlusions were noted and 3 major amputations had to be performed (one despite patent graft). 13 patients (76%) were available for duplex ultrasound examination after a mean follow-up of 59 months where patent grafts could be detected in all cases.


CONCLUSIONS
A multidisciplinary approach ensures optimal treatment strategy of arterial injury in extremity trauma. Interposition vein grafts provide durable long-term results and should be attempted even in single-vessel injuries of forearm and lower leg.
Department of Trauma Surgery, University Hospital, Mainz, Germany. dorweiler@htg.klinik.uni-mainz.de
B
B
Dorweiler
A
A
Neufang
W
W
Schmiedt
M H
MH
Hessmann
L
L
Rudig
P M
PM
Rommens
H
H
Oelert
D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001783:Blood Flow Velocity / Q000502:physiology; D001916:Brachial Artery / Q000293:injuries / Q000503:physiopathology / Q000637:transplantation; D003161:Compartment Syndromes / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D005121:Extremities / Q000098:blood supply* / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017534:Radial Artery / Q000293:injuries / Q000503:physiopathology / Q000637:transplantation; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000293:injuries / Q000503:physiopathology / Q000637:transplantation; D012720:Severity of Illness Index; D016019:Survival Analysis; D013995:Time; D016896:Treatment Outcome; D017535:Ulnar Artery / Q000293:injuries / Q000503:physiopathology / Q000637:transplantation; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency / Q000502:physiology; D014656:Vascular Surgical Procedures
D000925:Anticoagulants; D006493:Heparin