RSS-Feed abonnieren
DOI: 10.1055/s-2002-28471
A Modified Method of Microvascular Autogenous Interposition Vein Grafting for Vascular Reconstruction
Publikationsverlauf
Publikationsdatum:
13. Mai 2002 (online)
![](https://www.thieme-connect.de/media/jrm/200203/lookinside/thumbnails/10.1055-s-2002-28471-1.jpg)
ABSTRACT
A modified technique of vein grafting for vascular reconstruction that facilitates surgical procedures by preventing size, diameter, and length discrepancies as well as twisting, is presented. The distal end of the harvested vein graft is ligated, and the graft is inflated with heparinzed saline. The determination of the small side branches makes ligation easier. Gentle hydrostatic dilation relieves spasm, straightens the vein, and ligation of the proximal end is then performed under tension. As the vein inflated with heparinzed saline achieves maximum size, diameter, and length without torsion, the sausage-like graft can easily be interposed in tunnels, passages, or soft tissues between recipient vessel gaps. As the graft is under adequate tension, it is easy to determine its appropriate length, size, and diameter. Suturing is carried out using double approximating clamps. The graft will not twist or kink, as it is anastomosed under tension. The clamps are left in place until completion of the distal and proximal anastomoses. The distal clamp is released first.
With this simple modification, most of the technical difficulties, such as length, size, and diameter discrepancies, and twisting and torsion of the graft, can be eliminated. The risk of failure due to vascular thrombosis at the anastomotic sites is lowered, as the vein graft is filled with heparinzed saline, and no blood flow is permitted during the reconstruction. The surgeon also saves time with this easy, simple, and feasible method.
KEYWORDS
Autogenous interposition - vein grafting - method
REFERENCES
- 1 Hooley B C. History of vein grafting. Microsurgery . 1998; 18 234
- 2 Adcock Jr T O, Adcock G L, Wheeler J R. Optimal techniques for harvesting and preparation of reversed autogeneous vein grafts for use as arterial substitutes: a review. Surgery . 1984; 96 886
- 3 Harris J R, Seikaly H, Calhoun K, Daugherty E. Effect of diameter of microvascular interposition vein grafts on vessel patency and free flap survival in the rat model. J Otolaryngol . 1999; 28 152
- 4 Zhang F, Ho P R, Ozek C. Effect of vein grafting on the survival of microvascularly transplanted muscle flaps. Microsurgery . 1996; 17 512
- 5 O'Brien B McC. Microvascular Reconstructive Surgery. Edinburgh: Churchill Livingstone 1977: 102-118
- 6 Biemer E, Holzmann T, Wriedt-Lubbe I. Autologous vein grafts as artery replacement in microsurgery. An experimental study of micro and macromorphologic changes 3 weeks to 12 months postoperatively. Handchirurgie . 1981; 12 108
- 7 Green D P. Green's Operative Hand Surgery, 4th ed, volume 1. Philadelphia: Churchill Livingstone 1999: 1120
- 8 Albertengo J G, Rodriguez A, Buncke H J, Hall E J. A comparative study of flap survival rates in end-to-side microvascular anastomosis. Plast Reconstr Surg . 1981; 67 194
- 9 Schneider P, Pribaz J, Zook E G, Russel R C. Microvenous graft determination for arterial repair. Surg Forum . 1983; 34 631
- 10 Tubiana R. The Hand, vol 2. Philadelphia: WB Saunders Co 1985: 141-144
- 11 Jones J W. Adjunctive measures in microvascular surgery. J Reconstr Microsurg . 1997; 8 585
- 12 Hudson D A, Engelbrecht G, Duminy F. Another method to prevent thrombosis in microsurgery: an in situ venous catheter. Plast Reconstr Surg . 2000; 105 999
- 13 Biemer E. Role of vein grafts in reconstructive microsurgery. Microsurgery . 1998; 18 237
- 14 Cambria R P, Abbott W M. The autogenous vein as an arterial graft. In: Rutherford RB, ed. Vascular Surgery, 2nd ed Philadelphia: Saunders 1984: 367