Results of autogenous vein grafts in repair of major arterial injuries to the upper and lower extremities with reference to wall shear stress

Abstract

This investigation was designed to retrospectively review the results of autogenous vein grafts used for extremity arterial injuries. The mean value of the wall shear stress during a cardiac cycle was calculated by blood flow waveform analysis. The records of 103 patients with 106 arterial injuries repaired with autogenous vein grafts were reviewed. One hundred and two (96.2%) were patent in the early postoperative period. The mean length of follow-up was 6 years and 5 months (range 1–23 years). Fifty-one patients were followed beyond 1 year.

Of the 51 patients followed for more than 1 year, 49 (96.1%) patients had excellent peripheral circulation, however, two patients complained of mild ischemic pain. The patency of 26 of the 28 vein grafts was revealed by Doppler ultrasonic imaging studies. The excellent results obtained in this investigation reinforced our preference for using autogenous vein grafts for repair of extremity arterial injuries. The upper extremity grafts had a better outcome than those of the lower extremity; this was associated with a higher value of the wall shear stress. We propose that wall shear stress be measured for follow-up studies of vascular grafts in extremity arterial injuries and that hemodynamic factors should be considered during arterial reconstructive procedures.