Miscellaneous

Arterial Grafts for Vascular Reconstruction in the Upper Extremity

Trocchia AM, Hammert WC (Univ of Rochester Med Ctr, NY) J Hand Surg 36A:1534-1536, 2011^§

Abstract

Background

When direct arterial repair cannot be done to correct acute or chronic upper extremity ischemia, vascular grafts may be needed. Even if ischemia does not accompany isolated arterial injury, reconstruction can reduce symptoms such as cold intolerance. Grafts are ideally of the same diameter and vessel wall thickness as the original vessel, are readily available, are easy to harvest, and cause minimal donor site morbidity. Vein, artery, and synthetic grafts can be used, but generally the synthetic types are only used for larger vessels, such as the aorta, axillary, femoral, and popliteal vessels. A shift has occurred from vein grafts to arterial grafts. Each type of graft has advantages and disadvantages when used for vascular reconstruction in the upper extremity.

Vein Grafts

Vein grafts offer the advantages of ease of harvest and ready accessibility. They can be harvested from the same extremity, with different vessels used based on size requirements. Challenges associated with their use include the need for separate incisions for the various vessels, which can increase the risk of graft compression and occlusion. Veins have valves so the surgeon must either reverse the graft or remove the valves to ensure patency. Graft reversal can produce size mismatches, requiring vein narrowing or end-to-side anastomosis, complicating the procedure. Vein walls are thinner than artery walls, which can complicate the anastomosis. Even experienced surgeons can be challenged by vein graft procedures. Vein grafts can twist on themselves; a longitudinal mark can help maintain the correct orientation.

Arterial Grafts

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