Reilly Brendon, Khan Sikandar, Dosluoglu Hasan, Harris Linda, O'Brien-Irr Mollie, Lukan James, Dryjski Maciej, Blochle Raphael
Division of Vascular Surgery, Department of Surgery, University at Buffalo, Buffalo, NY.
Division of Vascular Surgery, Department of Surgery, University at Buffalo, Buffalo, NY.
Ann Vasc Surg. 2019 Nov;61:246-253. doi: 10.1016/j.avsg.2019.05.017. Epub 2019 Aug 2.
Surgical revascularization is the mainstay treatment in treating most traumatic arterial injuries, and autologous great saphenous vein is widely regarded as the conduit of choice. However, the use of the great saphenous vein may be limited by many factors, and there are little data to guide management in this setting. Bovine carotid artery graft (Artegraft, Inc., North Brunswick, NJ, USA) is a biologic conduit that has been used in select trauma cases at our center. The objective of this study was to review and compare our experience with autologous vein and bovine carotid artery in traumatic arterial injuries requiring bypass or interposition.
This is a retrospective review of all patients with a traumatic arterial injury repaired with autologous vein or bovine carotid artery graft at a single center between April 2014 and October 2016. Outcomes of interest included differences in duration of ischemia, operative times, patency, limb salvage, graft-related complications, and functional status.
Thirty patients were included in this study. Seventeen (57%) injuries were to the lower extremity (LE) and 13 (43%) to the upper extremity. Bovine carotid artery graft was used as a conduit in 12 (40%) cases, while autologous vein was used in 18 (60%) patients. Patients were predominantly male (90%). Mean age was 31 ± 15 years. Comorbidities did not differ significantly between the groups. Mean follow-up duration was 19 ± 13 months. Overall primary patency was 82%: bovine versus autologous vein (78% vs. 85%; P = 0.68). Overall secondary patency was 91%: bovine versus autologous vein (78% vs. 100%; P = 0.16). Overall limb salvage was 90%: bovine versus autologous vein (82% vs. 94%; P = 0.28). When comparing bovine carotid artery graft to autologous vein in LE interventions, primary patency (50% vs. 71%; P = 0.40), secondary patency (75% vs. 100%; P = 0.23), and limb salvage (80% vs. 86%; P = 0.76) did not differ significantly. There were no early or late graft infections with either conduit. There were no significant differences in ambulatory status at discharge by graft type. Overall survival was 100%.
In this series, there is a trend toward improved patency and limb salvage with autologous vein. Autologous vein should be the standard of care for revascularization of traumatic arterial injuries. Bovine carotid artery graft appears be a viable alternative, especially in patients requiring urgent revascularization, that does not significantly compromise patency, limb salvage, or functional outcomes.
外科血管重建是治疗大多数创伤性动脉损伤的主要方法，自体大隐静脉被广泛认为是首选的血管替代材料。然而，大隐静脉的使用可能受到多种因素的限制，且在这种情况下几乎没有数据可用于指导治疗。牛颈动脉移植物（美国新泽西州北布伦瑞克市的Artegraft公司生产）是一种生物血管替代材料，已在我们中心的部分创伤病例中使用。本研究的目的是回顾和比较我们在需要旁路移植或血管置换的创伤性动脉损伤中使用自体静脉和牛颈动脉移植物的经验。
这是一项对2014年4月至2016年10月期间在单一中心接受自体静脉或牛颈动脉移植物修复创伤性动脉损伤的所有患者的回顾性研究。感兴趣的结果包括缺血持续时间、手术时间、通畅率、肢体挽救情况、移植物相关并发症和功能状态的差异。
本研究共纳入30例患者。17例（57%）损伤位于下肢，13例（43%）位于上肢。12例（40%）患者使用牛颈动脉移植物作为血管替代材料，18例（60%）患者使用自体静脉。患者以男性为主（90%）。平均年龄为31±15岁。两组患者的合并症无显著差异。平均随访时间为19±13个月。总体原发性通畅率为82%：牛颈动脉移植物组与自体静脉组相比（78%对85%；P = 0.68）。总体继发性通畅率为91%：牛颈动脉移植物组与自体静脉组相比（78%对100%；P = 0.16）。总体肢体挽救率为90%：牛颈动脉移植物组与自体静脉组相比（82%对94%；P = 0.28）。在下肢干预中比较牛颈动脉移植物与自体静脉时，原发性通畅率（50%对71%；P = 0.40）、继发性通畅率（75%对100%；P = 0.23）和肢体挽救率（8支对86%；P = 0.76）无显著差异。两种血管替代材料均未发生早期或晚期移植物感染。出院时不同移植物类型的行走状态无显著差异。总体生存率为100%。
在本系列研究中，自体静脉有提高通畅率和肢体挽救率的趋势。自体静脉应成为创伤性动脉损伤血管重建的标准治疗方法。牛颈动脉移植物似乎是一种可行的替代方法，特别是在需要紧急血管重建的患者中，其不会显著影响通畅率、肢体挽救率或功能结果。
