Outcomes After Ipsilateral Great Saphenous Vein Bypass For Lower Extremity Vascular Trauma
Shamsh P. Shaikh, Daniel B. Alfson, Alexandra F. Forsyth, Fernando Brea, Maha Haqqani, Aaron Richman, Tejal S. Brahmbhatt, Jeffrey J. Siracuse, Alik Farber.
Boston University School of Medicine, Boston, MA, USA.
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. Data on the use of ipsilateral GSV conduits has not been reported.
We evaluated early- and long-term outcomes of ipsilateral GSV bypass in patients with traumatic lower extremity injury.
Electronic medical records of all patients with traumatic extremity vascular injury at a Level I trauma center between 2001 and 2019 were retrospectively reviewed. Patients who sustained lower extremity arterial injuries treated with ipsilateral GSV bypass were included. Patient demographics, injury characteristics, and operative details were examined. Outcomes included immediate revision of open repair, amputation, mortality, and ambulation status on follow up.
A total of 15 patients (93% male, 37.9 ± 4.7 years old) were repaired with ipsilateral GSV bypass. Major arteries damaged included popliteal (33.3%), common femoral (6.7%), superficial femoral (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 side (26.7%), relative accessibility (33.3%), and surgeon preference (40.0%). Notably, 50% of patients with bilateral lower extremity trauma also suffered concomitant ipsilateral femoral vein injury.
Three patients (20%) required immediate revision secondary to thrombosis or pseudoaneurysm. Of this subset, 2 patients required major amputation due to recurrent graft failure. Both instances of limb loss occurred in patients with blunt mechanism and concomitant long bone fracture.
Although one patient experienced acute limb ischemia after their initial hospitalization, no patients sustained subsequent limb loss or mortality. Data evaluating ambulation status are summarized in Table 1:
|Table 1: Ambulatory ability at 1-year median follow-up|
|Confined to wheelchair after amputation||2||13.3|
|Able to ambulate with assistance (AFO brace, crutches, cane)||9||60.0|
|Able to ambulate unassisted||4||26.7|
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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