Sato Kazuo, Ishijima Tatsuhiro, Kusunoki Kenichi, Yoshino Toshiki, Minegishi Mizuki, Nishida Yoshio, Murakami Hiroko, Tsuchida Yoshihiko, Bota Hiroki, Izawa Yuta
Orthopedic Trauma Center, Sapporo Higashi Tokushukai Hospital, Japan.
Department of Cardiovascular Medicine, Sapporo Higashi Tokushukai Hospital, Japan.
Trauma Case Rep. 2025 Aug 18;59:101240. doi: 10.1016/j.tcr.2025.101240. eCollection 2025 Oct.
Autologous vein grafting is a common method for revascularization in cases of traumatic limb arterial injuries. However, no clear guidelines have been established regarding the use of tourniquets following vascular reconstruction. We report a case of graft thrombosis that occurred during a planned orthopedic surgery one week after the initial revascularization. The patient was a 56-year-old man with a complex ligament injury of the left knee accompanied by a popliteal artery injury. After admission to our hospital, he underwent emergency popliteal artery reconstruction using an autologous vein graft. On postoperative day 8, the patient underwent ligament reconstruction under tourniquet control, which resulted in the thrombotic occlusion of the graft. Although repeat vein grafting was attempted intraoperatively, blood flow could not be restored. Ultimately, an endovascular stent was deployed in the popliteal artery, which successfully restored perfusion. At one-year follow-up, the stent remained patent without evidence of fracture or vascular stenosis. This case highlights the potential risk of tourniquet-induced graft thrombosis, particularly in the early postoperative period. Excessive pressure and dilation of a harvested vein may damage the intimal layer, thereby increasing thrombosis risk. In patients with recent vascular reconstruction, especially those at high-risk, the use of tourniquet should be carefully considered. When necessary, meticulous planning and prophylactic strategies are crucial to minimize the risk of graft failure.
自体静脉移植是创伤性肢体动脉损伤血管重建的常用方法。然而，关于血管重建后使用止血带的问题，尚未制定明确的指南。我们报告一例在初次血管重建一周后计划进行骨科手术期间发生移植物血栓形成的病例。患者为一名56岁男性，左膝复杂韧带损伤伴腘动脉损伤。入院后，他接受了自体静脉移植的急诊腘动脉重建术。术后第8天，患者在止血带控制下进行韧带重建，导致移植物血栓闭塞。尽管术中尝试再次进行静脉移植，但未能恢复血流。最终，在腘动脉中置入了血管内支架，成功恢复了灌注。在一年的随访中，支架保持通畅，没有骨折或血管狭窄的迹象。该病例突出了止血带引起移植物血栓形成的潜在风险，尤其是在术后早期。采集静脉的压力过大和扩张可能会损伤内膜层，从而增加血栓形成的风险。对于近期进行血管重建的患者，尤其是高危患者，应谨慎考虑使用止血带。必要时，精心规划和预防策略对于将移植物失败的风险降至最低至关重要。
