Vascular graft selection

Twenty to thirty per cent of patients with arterial injuries and some patients with venous injuries require interpositional grafting. The first choice of grafting material for both arterial and venous injuries is autogenous vein. Injuries to large vessels such as the aorta and superior vena cava may necessitate synthetic prostheses. Synthetic aortic prostheses have excellent long-term patency rates, but the same materials are much less likely to remain patent in the vena cava. Panel or spiral grafts constructed from saphenous vein appear to be the best replacement for this vessel. Autogenous veins are present in different diameters ranging from a mean of 6.4 mm in the saphenous vein to a mean of 1.8 cm in the internal jugular vein. The thickest autogenous vein is the saphenous vein, and thus it is preferred for medium-sized and small arteries. The authors prefer the larger 7.5-mm cephalic vein for replacement of medium-sized veins. In the absence of suitable saphenous vein, the cephalic vein is also the choice for arterial interposition grafts. Although there are few reports of the use of arterial autografts in vascular trauma, the surgeon should be aware that autografts may be ideal for vascular injuries in children and for isolated injuries with severe contamination. Finally, the use of synthetic grafts in injuries where adequate tissue coverage is not possible may result in immediate limb salvage, but the incidence of limb loss in this situation will be extremely high.