Outcomes following ipsilateral great saphenous vein bypass for lower extremity arterial injuries |
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| Affiliation: | 1. Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States;2. Division of Trauma, Acute Care Surgery and Surgical Critical Care, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, 840 Harrison Ave, Dowling 2 South, Suite 2509, Boston, MA, 02118, United States;3. Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States;1. R Adams Cowley Shock Trauma Center, University of Maryland, MD, 22 S Greene St, Baltimore, MD 21201, USA;2. Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada;3. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada;4. Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA;5. Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA;6. Department of Orthopaedic Surgery, Section of Orthopaedic Trauma, Duke University, Durham, North Carolina;7. Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA;8. Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, TX, USA;1. Department of Emergency, Changhai Hospital, Naval Military Medical University, Shanghai 200433, China;2. Institute of Translational Medicine, Shanghai University, Shanghai 200444, China;3. Southwest Jiaotong University College of Medicine, Southwest Jiaotong University Affiliated Chengdu Third People’ s Hospital, Sichuan 610036, China;4. Luodian Clinical Drug Research Center, Shanghai Baoshan Luodian Hospital, Shanghai University, Shanghai 200444, China;5. School of Medicine, Shanghai University, Shanghai 200444, China;1. Lecturer of Trauma & Orthopaedic Surgery, Cairo University, Egypt;2. Professor of Trauma and Orthopaedic Surgery, Cairo University, Egypt;3. Associate Professor of Trauma and Orthopaedic Surgery, Cairo University;1. Department of Trauma and Orthopaedics, Epsom and St Helier University Hospitals NHS Trust,;2. Department of Trauma and Orthopaedics, St Georges Hospital NHS Foundation Trust, UK;1. University of Minnesota Medical School, United States;2. AT Still University Kirksville College of Osteopathic Medicine, United States;3. City University of New York, York College, United States;4. Drexel University College of Medicine, United States;5. Department of Orthopedic Surgery, Mount Sinai Health System, New York, NY, United States;6. Department of Orthopedic Surgery, Boston University Medical Center, Boston, MA, United States |
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| Abstract: | ObjectiveUse of autologous great saphenous vein (GSV) grafts for repair of extremity arterial injuries is well established. Contralateral great saphenous vein (cGSV) is traditionally used in the setting of lower extremity vascular injury given the risk of occult ipsilateral superficial and deep venous injury. We evaluated outcomes of ipsilateral GSV (iGSV) bypass in patients with lower extremity vascular trauma.MethodsPatient records at an ACS verified Level I urban trauma center between 2001 and 2019 were retrospectively reviewed. Patients who sustained lower extremity arterial injuries managed with autologous GSV bypass were included. Propensity-matched analysis compared the iGSV and cGSV groups. Primary graft patency was assessed via Kaplan-Meier analysis at 1-year and 3-years following the index operation.ResultsA total of 76 patients underwent autologous GSV bypass for lower extremity vascular injuries. 61 cases (80%) were secondary to penetrating trauma, and 15 patients (20%) underwent repair with iGSV bypass. Arteries injured in the iGSV group included popliteal (33.3%), common femoral (6.7%), superficial femoral (33.3%), and tibial (26.7%), while those in the cGSV group included common femoral (3.3%), superficial femoral (54.1%), and popliteal (42.6%). Reasons for using iGSV included trauma to the contralateral leg (26.7%), relative accessibility (33.3%), and other/unknown (40%). On unadjusted analysis, iGSV patients had a higher rate of 1-year amputation than cGSV patients (20% vs. 4.9%), but this was not statistically significant (P = 0.09). Propensity matched analysis also found no significant difference in 1-year major amputation (8.3% vs. 4.8%, P = 0.99). Regarding ambulatory status, iGSV patients had similar rates of independent ambulation (33.3% vs. 38.1%), need for assistive devices (58.3% vs. 57.1%), and use of a wheelchair (8.3% vs. 4.8%) compared cGSV patients at subsequent follow-up (P = 0.90). Kaplan-Meier analysis of bypass grafts revealed comparable primary patency rates for iGSV versus cGSV bypasses at 1-year (84% vs. 91%) and 3-years post-intervention (83% vs. 90%, P = 0.364).ConclusionIpsilateral GSV may be used as a durable conduit for bypass in cases of lower extremity arterial trauma where use of contralateral GSV is not feasible, with comparable long-term primary graft patency rates and ambulatory status. |
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