Long-term Outcomes of Autologous Vein Bypass for Repair of Major Arterial Extremity Vascular Trauma
Forsyth AM, Alfson DB, Brea F, Shaikh SP, Haqqani M, Richman A, Brahmbhatt TS, Siracuse J, Farber A
Boston University School of Medicine, Boston, MA
Autologous vein is preferred for bypass in major arterial extremity vascular trauma(MAEVT) given lower infection risk and superior patency over synthetic grafts.
Demographics, injury characteristics, and short- and long-term outcomes were analyzed for trauma patients undergoing AVB at a single Level 1 trauma-center from 2001-2019 for injury to the axillary, brachial, femoral, or popliteal arteries.
107 patients(88% male, median age 28, 51% black, 27%smokers) underwent AVB for MAEVT. There were 34 UE(91% brachial) and 73 LE(56% femoral) injuries. Injury mechanism was penetrating in 77 patients(79% gunshot) and blunt in 23 patients(36% motorcycle crash). Median ISS was 10(range 4-41). Concurrent trauma included 23 nerve injuries and 40 orthopedic injuries. Bypass conduit was GSV in 103 patients; remainder were local veins in UE. Median index hospital stay: 11d(range 2-60). Median follow-up: 3.6 years(range 15d to 16.7y). Six patients developed claudication and 3 developed ALI. Sixty were discharged with antiplatelet therapy, and 39 on anticoagulation. Fifty-five patients had limb function return. 43/45 with limited limb function had orthopedic or nerve injury. Thirty-six patients underwent late graft imaging(9 symptomatic). Asymptomatic patients were surveilled for a median 249 days after MAEVT(range 7 days-11.4 years).
Repair of MAEVT with AVB is durable and requires infrequent reintervention. Loss of limb function is associated with orthopedic/neurologic injury. Mortality and major amputation were uncommon and associated with high ISS.
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