Do two venous anastomoses decrease venous thrombosis during limb reconstruction?

Iamaguchi, Raquel Bernardelli; Burgos, Felipe; Silva, Gustavo; Cho, Alvaro; Nakamoto, Hugo Alberto; Takemura, Renan Lyuji; Wei, Teng Hsiang; Rezende, Marcelo Rosa de; Mattar, Rames

doi:10.3233/ch-180467

Cited by 5 publications

(10 citation statements)

References 25 publications

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“…There have been conflicting reports on whether one-or two-vein anastomoses are optimal in lower extremity flap reconstructions. Several studies showed that two-vein anastomoses reduced complication rates compared with one-vein anastomoses [3,7]. Our results indicated that the venous thrombosis rates of two-vein anastomoses were lower than those of one-vein anastomoses (8.3% versus 30%, p = 0.07), and there was little biased distribution of high-risk factors between both groups.…”

Section: Venous Outflowmentioning

confidence: 43%

“…Furthermore, end-toside (ETS) venous anastomoses have been shown to be safe with a low rate of microvascular complications in lower extremity reconstructions [5,6]. However, there is some controversy over whether one-or two-vein anastomoses offer optimal venous outflow in these reconstructions [3,4,[7][8][9]. Heterogeneity in previous studies is attributable to the inclusion of various disorders such as oncologic and traumatic defects.…”

Section: Introductionmentioning

confidence: 99%

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Analysis of Anastomotic Venous Factors in Traumatic Lower Extremity Injuries Reconstructed by Free Flap

Shimbo¹,

Shinomiya²,

Sunagawa³

et al. 2022

Cureus

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BackgroundVenous thrombosis has been shown to be the most frequent cause of free flap failure in traumatic lower extremity injuries. However, the roles of various anastomotic venous factors, including venous anastomosis (end-to-end (ETE) or end-to-side (ETS)), venous outflow (one vein or two veins), and recipient venous selection (deep or superficial vein), remain unclear. This retrospective study aims to investigate factors contributing to microvascular complications in patients with lower extremity Gustilo type IIIB/IIIC injuries reconstructed by free flap with a focus on the three abovementioned venous factors. MethodsA total of 44 flap treatment outcomes of 41 patients with these injuries from 2015 to 2020 were assessed according to the three venous factors (type of anastomosis, venous outflow, and vein selection). ResultsThe average patient age was 52 years, with the majority (75.6%) being male. Eight patients (18.2%) returned to the operating room due to venous thrombosis, and five patients (11.4%) experienced total flap failure. The following factors were suspected to have contributed to venous thrombosis: vein size mismatch (n = 2) and recipient vein insufficiency possibly due to post-traumatic vessel disease (PTVD) (n = 6). End-to-side (ETS) anastomoses showed lower venous thrombosis rates than end-to-end (ETE) anastomoses (6.3% versus 25%, p = 0.22), two-vein outflows had lower rates than one (8.3% versus 30%, p = 0.07), and deep veins had the lowest thrombosis rates (7.7%), whereas superficial veins had the highest (38.5%). ConclusionThe key venous factors in preventing venous thrombosis include using as many two-vein ETS anastomoses as possible to deep recipient veins.

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Section: Venous Outflowmentioning

confidence: 43%

Section: Introductionmentioning

confidence: 99%

Analysis of Anastomotic Venous Factors in Traumatic Lower Extremity Injuries Reconstructed by Free Flap

Shimbo¹,

Shinomiya²,

Sunagawa³

et al. 2022

Cureus

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“…Following a meticulous screening process and study exclusion, the authors identified eight studies for review (Figure 1, Table 1). Flap loss rate: Flap loss rate was reported by six studies [8,[12][13][14][15][16] in total, with comparable results between one versus two venous anastomoses in ALT flap reconstruction. No significant difference was seen with an odds ratio assessment (P > 0.5), as demonstrated in Figure 2.…”

Section: Literature Search Resultsmentioning

confidence: 99%

“…No significant difference was seen with an odds ratio assessment (P > 0.5), as demonstrated in Figure 2. Venous congestion/thrombosis: Four studies [13][14][15]17] reported venous congestion and thrombosis comparing one versus two veins, but no significant difference was seen between the two groups, as demonstrated in Figure 3 below.…”

Section: Literature Search Resultsmentioning

confidence: 99%

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One Versus Two Veins in Free Anterolateral Thigh Flap Reconstruction: A Systematic Review and Meta-Analysis

Wright¹,

Rahman²

2022

Cureus

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There is considerable debate in the literature as to whether one or two venous anastomoses are optimal in the anterolateral thigh (ALT) free-flap reconstruction. The literature is currently devoid of a systematic review and meta-analysis of studies evaluating these procedures. This review will therefore be the first to address this clinical question. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, two authors (EW and SR) independently searched the following electronic databases: MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL). Case-control, randomised control and observational studies were included. The authors did not include case reports, case series, letters or abstracts. All patients were included regardless of age, comorbidity status, and the anatomical site of reconstruction. Venous congestion/thrombosis, flap take-back rate due to venous insufficiency, flap loss and operative time were the primary outcome measures. Secondary outcome measures included partial flap loss and haematoma formation. The Newcastle Ottawa Scale was used to assess the risk of bias in the included studies. Review Manager 5.4 data synthesis software was used for the analysis. The authors identified eight observational studies, with a total of 1741 patients reviewed, demonstrating a significantly lower flap take-back rate for a double venous anastomosis and a shorter operative time in the single venous anastomosis group. However, other reported measures, including venous congestion and flap loss, showed a non-significant difference (P>0.05). The limitations of the evidence included in this review were that all studies were observational in design. The flap take-back rate is significantly less when anastomosing two veins, and the authors recommend that utilising a second vein can circumvent the caveat of venous compromise.

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Association of Dual Venous Anastomosis with Reduced Risks for Flap Congestion in Microsurgical Lower Extremity Reconstruction: A Multicenter Study

Lee

Park

2022

J Reconstr Microsurg

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Background Flap congestion related with venous thrombosis is a major cause for microsurgical lower extremity reconstruction failure. Conducting dual venous anastomosis has been suggested to reduce risks for the adverse outcomes; however, its efficacy remains controversial. This study evaluated a potential association of dual venous anastomosis with the development of flap congestion in diverse clinical situations. Methods This multicenter study included patients who underwent microsurgical lower extremity reconstruction at two institutions. They were divided into two groups based on the number of venous anastomoses—single and dual groups. Their perfusion-related complications (PRCs), including total/partial flap loss, arterial or venous insufficiency, and emergent reoperation, were compared. Independent association of the number of venous anastomoses with the outcomes was evaluated. Further analyses were conducted using propensity score matching. Results In total, 225 cases were analyzed, of which 92 were included in the single group and the other 133 in the dual group. The two groups had generally similar baseline characteristics. The dual group presented significantly lower rates of PRC, including total/partial flap loss, flap congestion, and emergent reoperation. Multivariable analyses showed that conducting dual venous anastomoses was associated with reduced risks for the development of overall PRC and flap congestion. These associations were more prominent when restricting analyses for cases with chronic wound and trauma (vs. oncologic defects). Similar associations were observed in the propensity score matching analysis. Conclusion Conducting dual venous anastomosis seems associated with reduced risks for flap congestion in microsurgical lower extremity reconstruction, especially for cases with unfavorable conditions.

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Do two venous anastomoses decrease venous thrombosis during limb reconstruction?

Cited by 5 publications

References 25 publications

Analysis of Anastomotic Venous Factors in Traumatic Lower Extremity Injuries Reconstructed by Free Flap

Analysis of Anastomotic Venous Factors in Traumatic Lower Extremity Injuries Reconstructed by Free Flap

One Versus Two Veins in Free Anterolateral Thigh Flap Reconstruction: A Systematic Review and Meta-Analysis

Association of Dual Venous Anastomosis with Reduced Risks for Flap Congestion in Microsurgical Lower Extremity Reconstruction: A Multicenter Study

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