Outcome after interposition of vein grafts for arterial repair of extremity injuries in civilians

Abstract

Objective: The objective of this study was to report on immediate and long-term outcomes after vein graft interposition in patients with upper- and lower-limb arterial injuries.

Methods: In the retrospective data analysis, all patients who underwent vein graft repair of limb arterial injuries in our civilian institution since 1990 were included, analyzed, and followed. Study end points were crude early and long-term patency, vascular reintervention, limb salvage, and perioperative death.

Results: A total 152 consecutive patients (127 men; 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 with the use of vein graft interposition. The vast majority of lesions were caused by blunt trauma (n = 144; 91%). In early results, the 30-day mortality rate was 3.3%. In-hospital limb loss rate was significantly lower in the upper limb (n = 2; 2.9%) than in the lower limb (n = 12; 13.3%; P < .05). Primary early patency was 93% (upper limb) and 89% (lower limb): early graft occlusions occurred both in the upper limb (n = 5; 7%) and the lower limb (n = 10; 11%; P = .59). Occlusions were followed by amputation in six cases (upper limb: one of five; lower limb: five of 10) despite successful revision of the occluded grafts. Long-term results after a median follow-up period of 6.0 years (range, 0.3-23.4) showed upper limb (62% of patients were followed): no late limb loss, no vascular reintervention; patency: 97.6%; lower limb (66% of patients were followed): one late limb loss, one redo bypass for vein graft dilation, patency: 98.3%.

Conclusions: Emergency repair of civilian artery injuries with the use of vein grafts is associated with considerable risk of early occlusion and limb loss. When compared with the upper limb, limb loss rate is significantly higher in the lower extremity. Early graft occlusion is frequently followed by limb loss, especially in the lower limb. During long-term follow-up, occlusions of interposed vein grafts, vascular reinterventions, and late amputations are uncommon.