Results of venous interposition grafts in arterial injuries

Controversy continues regarding the use of PTFE versus autogenous vein grafts in the repair of arterial injuries. This study was designed to evaluate the results of a large series of autogenous interposition vein grafts used for arterial trauma. The charts of 191 patients with 192 arterial injuries repaired with an autogenous vein graft were reviewed. Specific areas of interest included graft-related complications such as thrombosis, infection, rupture, incidence of amputation, and mortality. Seventy-six per cent of the injuries were due to penetrating trauma. Forty-five per cent involved the upper and 51% the lower extremity. Shock (B. P. less than 80) occurred in one third of the patients. There were 23 (12%) graft-related complications. Sixteen (8.3%) of the grafts thrombosed. Three of these patients required an amputation and one a nephrectomy. Seven grafts (3.6%) became infected; all seven eventually ruptured. Five of these patients required an amputation. Eighteen patients (9.4%) required amputation; however, only eight (4.2%) of these cases were graft related. One patient died from non-graft-related multiple organ failure, establishing a mortality rate of 0.5%. Based on the data reported in this series, it is concluded that autogenous grafts continue to provide a safe, readily accessible, and effective means by which selected arterial injuries can be repaired.