OUTCOME OF COMPLEX VENOUS RECONSTRUCTIONS IN PATIENTS WITH TRAUMA

Purpose: The role of complex venous reconstructions (CVRs) in patients with major trauma remains a controversial topic. This study evaluates the patency and clinical outcome of CVRs in a major urban trauma cent er. Methods: Between 1979 and 1994 the records of 92 patients with 100 injuries to the iliac, femoral, and popliteal venous system were revi ewed. The incidence of edema, pulmonary embolism, and limb loss was do cumented in 75 men and 17 women (mean age of 27 years, range 14 to 59 years). The 30-day patencies were assessed in all patients with either impedance plethysmography (n = 16), venography (n = 40), or duplex sc an (n = 36). Long-term patencies were assessed in 14 patients monitore d for 0.5 to 9 years (mean 3.2 years). Results: Mechanisms of injury c onsisted of 58 gunshot wounds, 23 stab wounds, 6 shotgun wounds, and 5 blunt injuries. There were 112 associated injuries, 41 of which were concomitant arterial injuries. Forty-five of the 100 venous injuries w ere repaired with CVRs and included 6 (13%) spiral vein grafts, 8 (18% ) panel vein grafts, 8 (18%) reversed saphenous vein interposition gra fts, 8 (18%) end-to-end repairs, and 15 (33%) vein patch repairs. Thir ty-day patency rates for these repairs were 50%, 50%, 75%, 88%, and 87 %, respectively, and an overall patency rate of 73% was observed. The remaining 55 injuries were treated with ligation (n = 27) or lateral v enorrhaphy (n = 28). The cumulative 30-day patency rate for all venous repairs was 81% (59 of 73). Fourteen patients, nine of whom had CVRs, were available for long-term follow-up. In this group CVRs demonstrat ed a 100% patency. One patient with a spiral vein graft repair of the common femoral vein had severe reflux causing intermittent edema and m ild lipodermatosclerosis. No pulmonary emboli, limb loss, or deaths we re identified in patients undergoing CVRs. Conclusion: Patients with C VRs had a 30-day patency rate of 73%. Of this group panel and spiral v ein grafts were less successful, exhibiting only a 50% 30-day patency rate, whereas end-to-end and vein patch repairs were successful in 88% and 87% of cases, respectively. Our overall evaluation suggests that use of CVRs results hi successful venous repair; however, the postoper ative patency of interposition panel and spiral grafts suggests select ive use of these techniques.