Massachusetts Chapter of the American College of Surgeons

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Outcomes After Ipsilateral Great Saphenous Vein Bypass for Lower Extremity Vascular Trauma
Shaikh SP, Alfson DB, Forsyth AF, Brea F, Haqqani M, Richman A, Brahmbhatt TS, Siracuse JJ, Farber A

Background:
Use of autologous vein grafts for definitive repair of extremity arterial injuries is well-established. The contralateral great saphenous vein (GSV) is traditionally used in the setting of lower extremity vascular trauma given the elevated risk of occult ipsilateral deep venous injury. We evaluated outcomes of ipsilateral GSV bypass in patients with traumatic lower extremity injury.

Methods:
Electronic medical records of all patients with traumatic extremity vascular injury at a Level I trauma center between 2001 and 2019 were reviewed. Patients who sustained lower extremity arterial injuries treated with ipsilateral GSV bypass were included.

Results:
Fifteen patients (93% male) underwent repair with ipsilateral GSV bypass. Arteries damaged included popliteal (33.3%), CFA (6.7%), SFA (33.3%), and tibial (26.7%). Mechanism of injury was blunt in 4 patients (26.7%) and penetrating in 11 patients (73.3%), with mean Injury Severity Scores of 16.8 and 13.5 respectively. Reasons for using ipsilateral conduits included trauma to the contralateral leg (26.7%), relative accessibility (33.3%), and surgeon preference (40.0%). Notably, two patients with bilateral trauma also suffered concomitant ipsilateral femoral vein injury. Three patients (20%) required immediate revision secondary to graft occlusion. Two patients required amputation. Notably, both instances of limb loss occurred in patients with blunt mechanism and concomitant orthopedic fracture.

Conclusion:
In extremity arterial trauma, when use of contralateral GSV is not possible or feasible, ipsilateral GSV may be safely used as conduit for bypass.


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