Arteriovenous Vascular Loop Using a Bifurcated Greater Saphenous Vein

Abstract

Summary: High-energy lower limb trauma may result in complex defects with extensive vascular damage. Free flap reconstruction in these cases may require vein grafts to reach healthy proximal recipient vessels. Vascular loops are an increasingly popular technique in managing recipient vessels in reconstructive microsurgery, especially in the lower limb. The use of an entire omega segment of the greater saphenous vein had not been described before but offered two advantages: the caliber match for arterial repair was better using one of the limbs of the omega compared with the parent greater saphenous vein, and it allowed two venous anastomoses instead of one. A case report of a fully bifurcated segment of the greater saphenous vein as a vascular loop for microvascular reconstruction in the lower limb is presented. To the best of the authors’ knowledge, no similar case has been reported previously.

Reliability of Long Vein Grafts for Reconstruction of Massive Wounds

“…This study also sheds light on the employment of vein grafts to supercharge arterial pedicles via branch points and successfully demonstrates end-to-side anastomosis with long segment vein grafts, both of which represent innovative arrangements that expand upon the established techniques of AV loop creation, which typically involves the creation of an arteriovenous fistula with end-to-end coaptations between the flap vessels and an interpositional vein graft [5,7]. Cavadas et al presented a case involving bifurcated greater saphenous vein for double venous flow coaptation following AV loop creation, akin to the arterial supercharging seen in this series' Type 4 construct [22]. Moreover, the notably high proportion of vein grafts employed for extending venous pedicles (N = 5 in 10 cases) within this case series is a distinctive feature, as previous authors have predominantly described their use for either AV loop creation or arterial pedicle elongation [3][4][5][6][7].…”

Analysis of vein grafting versus arteriovenous loop in microvascular head and neck reconstruction: Multicenter series of 36 patients

“…The use of AV grafts to facilitate free tissue applications in head and neck reconstruction has previously been described in the literature 1,4,5,9–11,17 . Creation of an autologous AV loop graft can be the precursor for immediate simultaneous vein grafting or a delayed maturation yielding a true arteriovenous fistula.…”

“…4,13,[18][19][20] The use of AV grafts to facilitate free tissue applications in head and neck reconstruction has previously been described in the literature. 1,4,5,[9][10][11]17 Creation of an autologous AV loop graft can be the precursor for immediate simultaneous vein grafting or a delayed maturation yielding a true arteriovenous fistula. At the authors' institution, it is generally preferred to perform this secondstage definitive free flap reconstruction approximately 1 week following AV loop graft creation.…”

“…The use of vein grafts, often saphenous or cephalic, have been previously described in the literature to facilitate microvascular reconstruction by bridging gaps between the donor and recipient vessels as well as creating alternate vascular conduit from larger bore vessels. 1,3,4,[10][11][12][13][14][15][16][17] When both the artery and the vein require grafting, simultaneous vein grafts can be placed, or an arteriovenous loop can be created for later use following a brief period of maturation. Although the concept has been described previously, larger scale studies specific to the head and neck have yet to be reported.…”