REVASCULARIZATION OF THE LIMBS USING VEIN GRAFTS AFTER VASCULAR INJURIES

We report on 32 patients with vascular injury of a limb undergoing a t otal of 41 revascularization procedures with interposition vein grafts . A combined arterial and venous injury was present in nine cases, an isolated venous injury in four, and an isolated arterial injury in 19 cases. Eighteen per cent of patients with arterial injuries had normal distal pulses on initial examination. Preoperative arteriography was performed in 12 cases, and intraoperative arteriography in four. All v enous injuries were diagnosed at operation. In most cases, the contral ateral greater saphenous vein was used for grafting. Four patients had postoperative thrombosis after arterial reconstruction resulting in b elow knee amputation in two cases. Two patients suffered from postoper ative swelling caused by venous insufficiency one after ligation of an injured axillary vein, and the other one following venous thrombosis of a superficial femoral vein repair. It is concluded that revasculari zation of arterial and venous injuries of the extremities with interpo sition vein grafts is successful in most cases resulting in low amputa tion rates, and should be attempted in all major vascular injuries in viable limbs. (C) 1998 Elsevier Science Ltd. All rights reserved.