Document Detail


Choice of autogenous conduit for lower extremity vein graft revisions.
MedLine Citation:
PMID:  12170203     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Surgical revision to repair stenosis is necessary in about 20% of lower extremity vein grafts (LEVGs). Alternate conduit, especially arm vein, is often necessary to achieve a policy of all-autogenous revisions. Although basilic vein harvest necessitates deep exposure in proximity to major nerves, it typically uses a large vein unaffected by prior intravenous lines and as such appears ideally suited for revisions in which a segmental interposition conduit is needed for revision within the graft or for extension to a more proximal inflow or distal outflow site. In this report, we describe our experience with the use of the basilic vein for LEVG revisions compared with other sources of autogenous conduit.
METHODS: All patients who underwent LEVG were placed in a duplex scan surveillance program. LEVGs that developed a focal area of increased velocity or uniformly low velocities throughout the graft with appropriate lesions confirmed with angiography were candidates for revision. All patients who underwent graft revision with basilic vein segments from January 1, 1990, to September 1, 2001, were identified, and their courses were reviewed for subsequent adverse events (further revision or occlusion) and complications of harvest. These revisions were compared with revisions in which cephalic and saphenous vein were used.
RESULTS: One hundred thirty basilic veins were used to revise 122 LEVGs. The mean follow-up period after revision was 28 +/- 27 months. Ninety-three grafts (71%) remained patent with no further revision, and 37 grafts (29%) either needed additional revisions (22 grafts) or were occluded (15 grafts). Only four of these adverse events (11%) were directly attributed to the basilic vein segment. Ten of 43 grafts revised with cephalic vein (23%) were either revised or occluded, of which three were related to the cephalic vein segment (P = not significant, compared with basilic vein). Twenty-four of 81 grafts revised with saphenous vein (30%) were either revised or occluded, of which 11 were attributed to the saphenous vein segment (P <.01, compared with basilic vein). Two patients (1.5%) had complications from basilic vein harvest (one hematoma, one arterial injury). No neurologic injuries resulted from basilic vein harvest.
CONCLUSION: The basilic vein is a reliable and durable conduit when used to segmentally revise LEVGs. Stenoses rarely occur within interposed basilic vein segments, and excellent freedom from subsequent revision or occlusion is possible. We conclude the basilic vein can be safely harvested with minimal complications and is ideally suited for use as a short segment interposition graft for LEVG revision.
Authors:
Gregory J Landry; Gregory L Moneta; Lloyd M Taylor; James M Edwards; Richard A Yeager; John M Porter
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  36     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2002 Aug 
Date Detail:
Created Date:  2002-08-09     Completed Date:  2002-09-09     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  238-43; discussion 243-4     Citation Subset:  IM    
Affiliation:
Division of Vascular Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR 97201, USA. landryg@ohsu.edu
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MeSH Terms
Descriptor/Qualifier:
Arm / blood supply*
Constriction, Pathologic
Graft Occlusion, Vascular / surgery*
Humans
Leg / blood supply
Peripheral Vascular Diseases / surgery*
Reoperation
Tissue and Organ Harvesting
Ultrasonography, Doppler, Duplex
Ultrasonography, Interventional
Vascular Surgical Procedures* / adverse effects
Veins / pathology,  transplantation

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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