Potential Complications With Cryopreserved Cadaveric Veins in Arteriovenous Loop Formation for Head and Neck Microvascular Reconstruction

Abstract

Vessel depletion in the head and neck from radiation or previous surgical intervention adds to the operative complexity by limiting reconstructive options. Arteriovenous (AV) loop vascular grafts provide a conduit to bypass these nonviable local vessels to provide adequate blood flow. In certain situations, autologous donor vascular options are deficient or not readily available for creation of the AV loop. Cadaveric vein grafts provide an alternative option in these circumstances, but the efficacy and safety has not yet been delineated. In this study we discuss our experience utilizing cryopreserved cadaveric vein grafts for AV loop creation in head and neck reconstruction. In our initial cohort we aim to elucidate potential challenges and complications associated with the use of cadaveric vein grafts.

Analysis of vein grafting versus arteriovenous loop in microvascular head and neck reconstruction: Multicenter series of 36 patients

“…4,13,[18][19][20] The use of AV grafts to facilitate free tissue applications in head and neck reconstruction has previously been described in the literature. 1,4,5,[9][10][11]17 Creation of an autologous AV loop graft can be the precursor for immediate simultaneous vein grafting or a delayed maturation yielding a true arteriovenous fistula. At the authors' institution, it is generally preferred to perform this secondstage definitive free flap reconstruction approximately 1 week following AV loop graft creation.…”

Microvascular Reconstruction of the Anterior Skull Base

“…10 Another 2021 study also assessed vein utility in the context of vessel depletion due to radiation or previous surgical interventions, common occurrences in these complex reconstructions. 11 Investigators utilized cryopreserved cadaveric veins in patients without ideal autologous vein graft options, but they encountered higher rates of thrombosis compared to coldstored allograft. 11 Both studies emphasize the difficulties in navigating the complex surgical and medical history of these patients and reconciling them with the varied approaches for microvascular reconstruction.…”

“…A 2022 retrospective study found that use of single or dual vein anastomoses did not yield significant difference in complications or flap failure for craniofacial reconstruction 10. Another 2021 study also assessed vein utility in the context of vessel depletion due to radiation or previous surgical interventions, common occurrences in these complex reconstructions 11. Investigators utilized cryopreserved cadaveric veins in patients without ideal autologous vein graft options, but they encountered higher rates of thrombosis compared to cold-stored allograft 11.…”

“…11 Investigators utilized cryopreserved cadaveric veins in patients without ideal autologous vein graft options, but they encountered higher rates of thrombosis compared to coldstored allograft. 11 Both studies emphasize the difficulties in navigating the complex surgical and medical history of these patients and reconciling them with the varied approaches for microvascular reconstruction. These further highlight the surgeon's preoperative planning and intraoperative expertise as large driving factors for assessing vessel lie and utility or flap viability and achieving positive surgical outcomes.…”

“…Among another cohort of Asian rhinoplasty patients, a 10.7% complication rate was observed with silicone-PTFE composite implants. 11 No cases of extrusion were noted in that sample, and issues were limited to malposition (5.4%), erythema (2.3%), and infection (1.1%). Overall, the literature demonstrates that complication rates of synthetic implants (approximately between 1% and 10%) are comparable to that of autogenous cartilage with the additional uncommon risk of extrusion.…”