Multifactorial effects on the patency rates of forearm arterial repairs

Abstract

It is clear that the late clinical symptomatology and the patency of forearm arterial repairs have been contradictory. This study, during which the relationship between the symptomatology and patency has been studied, explores the influence of the local hemodynamic changes and the effect of microsurgical technique on patency rates. Thirty-five patients with a total of 44 arterial injuries were treated. Hemodynamic studies were done intraoperatively, and all patients were evaluated postoperatively with a neurologic, vascular, clinical examination and by radiodiagnostic methods. An overall patency of 77.2% was found. Color-Doppler ultrasonography (CDU) failed by 14.2% as compared with angiography, which did not fail. High blood pressure on the distal stump led to significantly reduced patency rates. Eight patients without nerve problems were found to be symptomatic as a result of the poor patency rate. Many factors are observed to influence patency rate. The nonpatent forearm artery can be symptomatic in anatomically and hemodynamically varied hands. CDU was more reliable for hemodynamic evaluation; conversely, angiography was more dependable for arterial morphology. The results of this study suggest that to correlate the clinical symptomatology and the patency rates, all arterial repairs should be assessed both clinically and radiodiagnostically.

Is there an association of hematopoietic stem cell and endothelial progenitor cell markers with maturation in forearm arterial repair?

“…[14] In addition, it has been shown that there is lesser endothelial damage and better outcomes, after vessel repairs are achieved by using microsurgery techniques. [15,16] Despite the lack of ischemic findings, we performed arterial repair via microsurgery techniques in our patients to achieve a better long-term outcome, which is in agreement with the literature.…”

“…[19] Studies on the timing of Doppler sonography recommend that it should be performed at least three weeks after injury and that results should be interpreted by comparing them with the uninvolved side. [15] In our study, we performed Doppler sonography at week six after surgery and compared arterial flow rates with the uninvolved side in the same patient. Blood flow was considered as occluded (insufficient maturation) if the blood flow rate was <50% when compared to the uninvolved side while patent (sufficient maturation) if it was >50%.…”

Multiple Digital Gangrene after a Radial Artery Penetrating Injury: A Case Report

“…21 It has been noted that even though the patency following repair of radial or ulnar artery lacerations may not exceed 50%, digital ischemia rarely occurs 21 and clinical symptomatology can be contradictory to the actual patency of forearm arterial repairs. 21,22 Digital gangrene following radial arterial injury is very rare and is almost always reported as the result of thromboembolic occlusion of the radial artery or the superficial palmar arch following PCRA. After cannulation, 27.5% of patients develop abnormal radial artery flows, with 10% having absent pulses but none having any symptoms of hand ischemia.…”

Forearm Arterial Vein Grafting: Problems and Alternative Solutions

“…If the pressure difference between the proximal and distal stumps is low or negative, stasis, turbulence and thrombosis are seen in the graft. 20 The properties of vein grafts are important in determining early and late phase patency rates. Veins have six times more expansibility and four times more volume storage capability than arteries, corresponding to a 24-fold increase in compliance.…”

“…When repair is delayed, vasospasm develops and, especially in single arterial injuries, flow will shift to the intact artery leading to increased backflow in the distal stump. 12,20 Using 'fit vein grafts', in terms of diameter and length, can prevent increased compliance, and the wash-up and dilatation procedures, to detect the axis and correct narrowing of the graft, should be done gently. Saphenous vein grafts are the largest autologous grafts and can be 2.5 -3 times the FIGURE 2: Flow in the graft comes from both proximal and distal directions, so valves behave like an umbrella opening, closing and reversing, which in turn increases turbulance and reduces flow.…”