Long-term results of venous reconstruction after vascular trauma in civilian practice

Abstract

The natural history of venous reconstruction (VR) in terms of patency and clinical outcome after vascular trauma has not been well documented. This study consists of 32 patients who had VR performed for extremity vascular trauma and were available for long-term assessment (mean follow-up time 49 months, range 6 to 108 months). The types of repair performed were as follows: lateral venorrhaphy (simple repair) (56%), interposition grafting (22%), patch repair (12.5%), and end-to-end repair (9.5%). Seventeen patients underwent venography after the operation with documentation of repair patency in eight patients (46%) and thrombosis in nine (54%). Only two patients had significant clinical edema at follow-up examination. Noninvasive venous evaluation consisted of Doppler ultrasonography, impedance plethysmography, photoplethysmography, and color-flow duplex scanning (CFDS). The photoplethysmography-derived venous refilling time of the injured extremity was 34.9 +/- 16.2 seconds whereas that of the contralateral noninjured extremity was 36.8 +/- 16.1 seconds (p = 0.5). Based on standard criteria for CFDS, 90% of VRs were patent. Eight repairs that were patent in the early postoperative period remained patent on CFDS. Of the nine repairs with early thrombosis, eight were assessed as patent on follow-up CFDS. In conclusion, VR is a durable surgical procedure associated with minimal morbidity, good long-term patency, and preservation of venous competence. The natural history of thrombosed VRs appears to be one of thrombus absorption with recanalization.

Use of Ipsilateral Superficial Femoral Vein for Common Femoral Vein Reconstruction After Trauma: A Useful Approach in Selected Cases

“…4,6 Thus in otherwise uncomplicated venous repairs, a filter is not necessarily indicated. Moreover, even when venous repairs thrombose early on, a significant percentage will recanalize and remain patent long term as reported by Nypaver et al 18 Whether this is more likely to occur with SFV use as opposed to other grafts especially prosthetic is not clear, although one might speculate that it should. In view of all this, we did not use systemic anticoagulation, especially given our patient's initial coagulopathy.…”

Complete Femoral Artery and Vein Avulsion from a Hyperextension Injury: A Case Report and Literature Review

“…Short-term patency may facilitate the development of collateral circulation, and a thrombosed vein graft may recanalize. 29 The high flow through the femoral vein may contribute to increased patency, and overall limb salvage does not appear to be affected by the failure of venous repair. [28][29][30] Prior to the completion of the femoral vein anastomosis, the first 100-200 mL of venous blood was flushed out in order to prevent additional toxic anaerobic metabolites from being introduced into the systemic circulation.…”

“…29 The high flow through the femoral vein may contribute to increased patency, and overall limb salvage does not appear to be affected by the failure of venous repair. [28][29][30] Prior to the completion of the femoral vein anastomosis, the first 100-200 mL of venous blood was flushed out in order to prevent additional toxic anaerobic metabolites from being introduced into the systemic circulation. We performed a completion duplex ultrasound to eliminate the chance of contrast nephropathy in the setting of a patient who was already at high risk of acute renal failure from rhabdomyolysis.…”

Analysis of the operation of the SCD Response intermittent compression system

“…Most systems compress for usually 5 12 s, and then have a de ated period for 48 -60 s, before rein ating. The rest period allows the veins that have been emptied during compression to re ll, and since 40 s is thought to be roughly the average for the time taken for a limb to re ll in the supine position [7], a rest of 48 -60 s will ensure that the limbs of the majority of patients are re lled properly. However, if a patient has a relatively short typical venous re ll time, 30 s for instance, then with a 60-s rest there will be 30 s of dead time where the limbs are re lled, but the compression system is not operating.…”