Fate of the exposed saphenous vein graft

Article Abstract:

A serious complication of peripheral vascular surgery (surgery on the blood vessels of the limbs) is when the vascular graft becomes exposed to the environment. This may occur if the wound does not heal properly, often because the patient is diabetic or the wound has become infected. If this occurs and the graft is prosthetic (artificial), the graft is usually removed. But in the case of exposure of a autogenous (from the patient's own body) graft, an attempt should be made to preserve it. Laboratory experience with dogs has suggested that grafts respond differently to various bacteria. Infection with staphylococcus bacteria cleared without antibiotic use, whereas infection with gram-negative bacteria resulted in graft-wall disintegration in the dogs. The cases of 16 patients with exposed saphenous vein (in the leg) grafts were reviewed to determine the cause of the infection and the best method of treatment. The average age of the patients was 73, and 11 patients had diabetes. Eight of the 16 patients had a foot infection at the time of the graft surgery. The graft became exposed an average of six days after graft surgery. All patients were initially treated with antibiotics, moist sterile dressing changes and split-thickness skin grafts to cover the exposed area. This treatment was successful for seven patients; but seven patients developed hemorrhage and two patients had graft thrombosis (clot formation). The bacteriology of the graft infection was the most important determinant of graft rupture and subsequent hemorrhage. When the wound was not infected or grew gram-positive bacteria, the rate of graft rupture was 25 percent, but graft rupture occurred in all cases of gram-negative bacterial infection. Placement of a second graft was not successful when the initial infection was caused by gram-negative bacteria. These data suggest that for patients with exposed vein grafts, the outcome is dependent on the bacteria causing the infection. Patients without gram-negative infection may require only local wound care. Patients with gram-negative infection may need further, more involved surgery to correct their circulatory problems. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Complications and side effects, Peripheral vascular diseases, Autografts

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Results of in-situ saphenous vein bypass to the foot

Article Abstract:

It is generally accepted that diseased arteries in the leg can be bypassed in order to reestablish blood supply and prevent loss of the leg due to ischemia (decreased blood supply). The ischemia is typically caused by atherosclerosis, cholesterol plaque formation on the lining of the artery wall. Controversy surrounds the methodology used to achieve the reconstruction of these arteries, in particular what route should be utilized to provide bypass of the blocked artery. One hundred fifteen lower leg vessel bypasses performed on 113 patients were studied. Group 1 consisted of 91 bypasses to the tibial vessels in the calf; group 2 consisted of 24 bypasses to the ankle or foot vessels located lower down the leg. Group 2 patients required bypass to the lower ankle and foot vessels because of severe disease in the vessels of the calf. The reason for the surgery was leg-threatening ischemia in 94 percent of patients, and claudication (weakness and cramps of the legs) in 6 percent. Three years later, the groups were compared in terms of leg salvage, graft patency (ability of the graft to remain open and allow the flow of blood), and functional status (ability to walk). There were no statistically significant differences between the groups on these factors. Diabetes was not found to influence the outcome of reconstructive surgery, and preoperative testing was not predictive of outcome. It is concluded that patients with severe ischemia of the lower leg may benefit from bypass to the vessels of the ankle and foot, with success rates similar to those of bypasses performed further up the leg. (Consumer Summary produced by Reliance Medical Information, Inc.)

Leg, Blood vessels, Atherosclerosis

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Extraanatomic bypass for peripheral arterial injuries

Article Abstract:

In the general population, injuries to the arteries have increased in recent years. This is a result of the increased use of shotguns and high-velocity guns by criminals. These injuries are often complicated by infections in the peripheral arteries. A large percentage of these patients require resection (removal) of a segment of the artery with placement of a vascular graft. Frequently, coverage of this artificial conduit, or graft, is difficult because of injuries to the muscles and soft tissue overlying the vascular injury site. One technique used is extraanatomic bypass grafting, which involves placement of a vein bypass graft in a position that is not normal anatomically, and is thus able to avoid the area of soft tissue injury. Indications for use of an extraanatomic bypass graft include combined soft-tissue and arterial defects, wound infection with rupture of the arterial repair, or combined soft-tissue and arterial infections. Results obtained over an eight-year period in which this procedure was performed on 12 patients are presented. The cause of injury was gunshot wound in six patients. The procedure was successful in 11 patients, with adequate wound coverage or closure accomplished and good distal arterial flow preserved. This procedure has not only provided protection of the vein graft, but also has allowed appropriate treatment of the open wound. Earlier rehabilitation and better functional outcome can be expected. (Consumer Summary produced by Reliance Medical Information, Inc.)

Injuries, Arteries, Gunshot wounds

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