Role of Arteriovenous Vascular Loops in Microsurgical Reconstruction of the Extremities

Abstract

Objective:To analyze 10 consecutive cases of microsurgical arteriovenous loops created to reconstruct complex injuries from March 2011 to May 2012. Methods:This observational cohort-type study conducted by the Hand and Microsurgery Group at the HC-FMUSP included patients who were candidates for microsurgical reconstruction as a last alternative to amputation of the limb with proven absence of adequate recipient vessels for primary microsurgical anastomosis, in a prospective and consecutive manner. We analyzed 14 variables (epidemiological, clinical, procedure-related, and outcome) in patients who underwent reconstruction using an arteriovenous loop utilizing a single-stage or two-stage procedure. Results:The injuries were mostly traumatic (80%). The success rate of the single-stage procedure was 75%, and 17% for the two-stage procedure. The rate of preservation for the injured limb was 44%. Conclusion:This study reinforces the more recent understanding that the indication for single-stage or two-stage reconstruction should be individualized; our findings favor the single-stage reconstruction. This technique should be used in selected cases, as a last reconstructive alternative before amputation, and further studies are necessary to confirm its safety and efficacy in our practice. Level of Evidence IV; Case series.

Complex microsurgical perineal reconstruction after resection of a giant verrucous carcinoma associated with anal fistulas in Crohn’s disease—a unique case report

“…Reconstructive surgery involving free flap tissue transfer in combination with an AV loop has been reported as single- or two-stage procedure [ 19 , 20 , 22 ]. In the current case, cardiomyopathy, in particular, prevented extensive duration of anesthesia.…”

Efficacy of the Arteriovenous Loop for Free Flap Reconstruction in Patients with Complex Limb Trauma: Case Series and Literature Review

“…These advantages allowed for a clear vision of potential complications in the loop prior to flap transfer. Moreover, Silva GB and colleagues [ 27 ] reported no statistical difference between the single-stage and two-stage procedure.…”

Heterogeneous Maturation of Arterio-Venous Fistulas and Loop-Shaped Venous Interposition Grafts: A Histological and 3D Flow Simulation Comparison

“…Concerning the commonly used artificial arterio-venous fistulas and the rarely applicable loop-shaped grafts (arterial or venous interposition), failure is still a challenging problem [ 2 , 7 , 8 ]. Arterio-venous interposition grafts can be used in clinical reconstructive microsurgery when proper vessels are not available or long enough in free flap operations [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. Loop-shaped arterial grafts can be used as an alternative method for vascular access when Cimino fistula creation is not possible [ 20 , 21 , 22 ].…”