Efficacy and durability of autogenous saphenous vein conduits for lower extremity arterial reconstructions in preadolescent children

Objective: Limb length discrepancies (LLDs) in growing children may accompa ny extremity arterial occlusions. Revascularization with vein grafts has be en questioned because of degenerative graft changes observed at other sites . This study was undertaken to define vein graft durability and efficacy in lower extremity revascularizations in preadolescent children. Study design: Fourteen children (10 boys, 4 girls) with a mean age of 7.3 y ears (range, 2-11 years) who underwent 16 lower extremity revascularization s with greater saphenous vein grafts were subjected to follow-up with graft ultrasonography, ankle/brachial indices (ABIs) with and without exercise, and limb length determinations. A mean of 5.7 years elapsed between the ons et of ischemia and operation. Arterial occlusions resulted from cardiac cat heterizations (11), arteritis (1), dialysis cannulation (1), and penetratin g trauma (1). Indications for operation included LLD (6), claudication (4), both LLD and claudication (3), markedly diminished ABIs with a potential f or LLD (2), and a traumatic transection with hemorrhage (1). The reconstruc tions with 15 reversed and one in situ vein grafts included iliofemoral(ll) , femorofemoral (1), aortofemoral (1), femoropopliteal (1), popliteal-popli teal (1), and popliteal-posterior tibial (1) arterial bypass grafts. Results: Among patent grafts available for follow-up, 36% (5 of 14) remaine d unchanged, 50% (7 of 14) developed nonaneurysmal dilatation, and 14% (2 o f 14) exhibited nonprogressive aneurysmal expansion. One graft became occlu ded, and one graft was lost to follow-up. Collectively, the grafts manifest an 11.2% expansion at an average of 10.7 years postoperatively. ABIs incre ased from 0.75 preoperatively to 0.97, at an average of 11.0 years postoper atively. LLDs were reduced from 1.66 to 1.24 cm, at an average of 11.4 year s postoperatively. Conclusion: Vein graft reconstructions of lower extremity arteries in pread olescent children are durable. They provide an efficacious means of restori ng normal blood flow, and in 70% of children their preexisting LLDs were re duced.