Forearm Arterial Vein Grafting: Problems and Alternative Solutions

Abstract

We aimed to evaluate patency rates following forearm arterial reconstruction and suggest improvements. Thirty-two vein grafted reconstructions (using saphenous and dorsal hand veins) were evaluated for patency and development of symptoms using clinical examination, Colour-Doppler Sonography and angiography. Overall patency was 59%, with no significant difference between saphenous and dorsal hand veins. Stasis, turbulence, decrease in blood velocity, change in flow pattern, stenosis in the anastomotic area or increase in compliance was detected in 10 patent grafts, but was not associated with symptoms. Six out of 13 non-patent grafted patients had severe or troublesome symptoms associated with accompanying nerve regeneration. To improve patency, careful microsurgical techniques, 'fit vein' and valveless grafts should be used. Dorsal hand veins are most appropriate for short defects. Patency should be evaluated soon after reconstruction.

Patterns of Superficial Veins of the Middle Upper Extremity in Caucasian Population

“…Superficial veins are not paired with any artery and their anatomical disposition varies widely unlike the deep veins. Cephalic, basilic, and antebrachial vein are usually the major superficial veins of middle upper extremity, but other veins are more frequently variable in existence and arrangement (1, 2).…”

“…Superficial veins of the lower or upper extremities are vein graft sources. Despite their anatomical variations, surgical dissections of the superficial veins are fast and easy to perform (1, 2).…”

Diffusion of bioactive molecules through the walls of the medial tissue‐engineered hybrid ePTFE grafts for applications in designs of vascular tissue regeneration

“…Thus, autologous saphenous veins or internal mammary arteries are currently employed as small caliber grafts to bypass occluded peripheral and coronary arteries 6. The low patency of the veins and supply limitations of the arteries have not eliminated the need for artificial small diameter vascular grafts 7…”