Management and short-term patency of lower extremity venous injuries with various repairs

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

“…The management and repair of lower extremity venous injuries is controversial, and no approach (ligation vs. vein or prosthetic graft reconstruction) has been shown to be preferable for optimal patient outcome. 28 The natural history of most venous repairs is that they ultimately thrombose regardless of repair technique; however, there are several points to consider. 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. 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.…”

Lower Extremity Vascular Trauma

“…Parry et al examined the short-term patency of several methods of extremity vein repair in a civilian trauma setting and found a patency rate of nearly 75% regardless of the type of reconstruction (primary repair, vein patch angioplasty, interposition graft). 34 This group also reported that a large number of venous repairs that had thrombosed in the early time period went on to recanalize over time. In a longer follow-up study, Kuralay et al reported that patency was predicted by the anatomic position of the venous injury rather than by the type of repair.…”

“…As part of their advantage, placement of temporary vascular shunts is generally quick and allows for manipulation and stabilization of concomitant orthopedic fractures before the shunt is removed and consideration given of vascular repair. 34 Lateral venorrhaphy is the simplest method to repair venous lacerations while end-to-end anastomosis and patch venoplasty are useful for repair of veins without segmental loss. For injuries that destroy large portions of the vein, an interposition graft using autologous vein or prosthetic conduit is the preferred approach.…”

Surgical Damage Control and Temporary Vascular Shunts

“…All venous shunts in their series were patent on reexploration at a mean 22 hours dwell time. 32 In select distal vascular injuries, use of temporary vascular shunts is acceptable or even preferred. Specifically, injuries in which more than one of the redundant vessels to the extremity or end-organ are injured may result in a scenario in which viability depends on restoration of flow through one of the severed vessels.…”