A Review of Arterial Grafts Used for Microvascular Arterial Reconstruction

Abstract

Arterial grafts are sometimes used in microvascular reconstruction and their clinical benefit over standard venous grafts is unknown. To determine arterial graft utilization in clinical microvascular arterial reconstruction, a review of the literature was done. PubMed search resulted with 4,352 finds, and after screening for relevance, 11 articles reporting on 55 arterial grafts were analyzed. All reports were retrospective studies, case reports, and case series, with no randomized controlled trials. Two retrospective series reported better patency of arterial versus venous grafts in upper-limb revascularization for chronic occlusion, but the findings were highly biased. Better patency of arterial grafts did not lead to higher rate of clinical improvement. Antiplatelet and lipid-lowering agents seem to be underused in venous graft recipients and use of no-touch venous grafting has not been reported. Based on the available data, routine use of arterial grafts cannot be recommended. Studies that show better patency of arterial grafts in hand revascularization for chronic vascular insufficiency are retrospective and biased, so a randomized controlled trial is needed.

Deep inferior epigastric artery donor for hypothenar hammer syndrome reconstruction: a case series

“…Furthermore, the ulnar artery at the wrist is the most common site of arterial aneurysms of the 2 In retrospective trials, arterial grafts have been shown as superior to venous grafts in upper limb arterial vasculature reconstruction, however, these benefits must be offset against possibly greater donor site morbidity and more limited donor site options. [7][8][9][10] Alterations in flow dynamics within venous grafts subjected to arterial pressures have been shown to result in intimal hyperplasia causing partial or complete graft occlusion in up to 50 per cent of reconstructions, as well as long term dilation. 11,12 Utilising an arterial graft adheres to the reconstructive principle of replacing 'like with like' and provides a graft more suited to the high-pressure arterial system.…”

“…7,8,11,12,14 A recent expert review assessing arterial grafts compared to venous grafts in microvascular Deep inferior epigastric artery donor for hypothenar hammer syndrome reconstruction: a case series Australasian Journal of Plastic Surgery reconstruction of hand vessels recommended against their routine use due to donor site morbidity and a lack of well designed, prospective studies showing their reconstructive superiority. 10 While not yet widely available, synthetic conduits may also represent a superior reconstructive option in the future.…”

Resurfacing of lower extremities: Versatility of thigh flap as pedicle extension graft with consecutive thoracodorsal artery perforator‐based flap

“…According to previous reports, many arterial conduits are available for harvest, including the subscapular, anterior, and posterior interosseous, radial, ulnar, superficial inferior epigastric, deep inferior epigastric, and dorsalis pedis arteries (Papes, 2021; Rockwell et al, 2003). Among them, the descending branch (DB) of the lateral circumflex femoral vessels (LCFVs) is quite suitable because of its long length, good diameter match between vessels, consistent anatomy, and ease of harvesting with various adjacent flaps (Echo & Bullocks, 2011; Frommer et al, 2021).…”