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Deep vein harvest: predicting need for fasciotomy
J Gregory Modrall1, Javid Sadjadi, Ahsan T Ali
1Department of Surgery, University of Texas Southwestern Medical Center and Dallas Veterans Affairs Medical Center, Dallas, TX 75390-9157, USA. greg.modrall@utsouthwestern.edu
Journal of Vascular Surgery
|January 27, 2004
Summary
Deep vein harvest for arterial reconstruction can lead to acute compartment syndrome, requiring fasciotomy in 17.8% of cases. Lower preoperative ankle-brachial index and concurrent greater saphenous vein harvest are key predictors.
Area of Science:
- Vascular Surgery
- Surgical Complications
- Lower Extremity Reconstruction
Background:
- Deep thigh veins are vital autogenous conduits for arterial reconstruction.
- Deep vein harvest can cause venous hypertension and predispose to acute compartment syndrome.
Purpose of the Study:
- Determine the frequency of fasciotomy after deep vein harvest.
- Identify clinical predictors for fasciotomy necessity post-deep vein harvest.
Main Methods:
- Retrospective analysis of 162 patients undergoing arterial reconstruction with deep vein harvest over 9 years.
- Data collected on patient demographics, surgical indications, and fasciotomy rates.
- Logistic regression used to identify predictors of fasciotomy.
Main Results:
- Fasciotomy was performed in 17.8% of 264 harvested limbs.
- Higher fasciotomy rates observed in aortofemoral reconstruction (20.6%) and complete deep vein harvest.
- Lower preoperative ankle-brachial index (ABI) and concurrent ipsilateral greater saphenous vein (GSV) harvest were significant predictors of fasciotomy.
Conclusions:
- Approximately 25% of patients undergoing deep vein harvest for aortofemoral reconstruction may require fasciotomy.
- Patients with severe lower extremity ischemia and those undergoing simultaneous GSV and deep vein harvest face the highest risk.
- Prophylactic fasciotomy may be considered for high-risk patients, with continued vigilance for compartment syndrome essential.