Outcome after interposition of vein grafts for arterial repair of extremity injuries in civilians.

OBJECTIVE: The objective of this study was to report on immediate and long-term outcomes after vein graft interposition in patients with upper- and lower-limb arterial injuries. METHODS: In the retrospective data analysis, all patients who underwent vein graft repair of limb arterial injuries in our civilian institution since 1990 were included, analyzed, and followed. Study end points were crude early and long-term patency, vascular reintervention, limb salvage, and perioperative death. RESULTS: A total 152 consecutive patients (127 men; median age, 31.7 years; range, 5.3-77.2) who presented with 158 lesions of limb arteries (lower limb: n = 90; upper limb: n = 68) underwent repair with the use of vein graft interposition. The vast majority of lesions were caused by blunt trauma (n = 144; 91%). In early results, the 30-day mortality rate was 3.3%. In-hospital limb loss rate was significantly lower in the upper limb (n = 2; 2.9%) than in the lower limb (n = 12; 13.3%; P < .05). Primary early patency was 93% (upper limb) and 89% (lower limb): early graft occlusions occurred both in the upper limb (n = 5; 7%) and the lower limb (n = 10; 11%; P = .59). Occlusions were followed by amputation in six cases (upper limb: one of five; lower limb: five of 10) despite successful revision of the occluded grafts. Long-term results after a median follow-up period of 6.0 years (range, 0.3-23.4) showed upper limb (62% of patients were followed): no late limb loss, no vascular reintervention; patency: 97.6%; lower limb (66% of patients were followed): one late limb loss, one redo bypass for vein graft dilation, patency: 98.3%. CONCLUSIONS: Emergency repair of civilian artery injuries with the use of vein grafts is associated with considerable risk of early occlusion and limb loss. When compared with the upper limb, limb loss rate is significantly higher in the lower extremity. Early graft occlusion is frequently followed by limb loss, especially in the lower limb. During long-term follow-up, occlusions of interposed vein grafts, vascular reinterventions, and late amputations are uncommon.

Incidence and predisposing factors of cold intolerance after arterial repair in upper extremity injuries.

OBJECTIVE: The purpose of this report was to present abnormal posttraumatic cold intolerance in patients that previously underwent repair of arterial injuries after civilian upper limb trauma in our institution. METHODS: All patients who underwent repair of arterial lesions after upper limb trauma since 1990 were reviewed, and clinical follow-up studies were performed. Patients were asked to complete the cold intolerance symptom severity (CISS) questionnaire to evaluate presence and severity of self-reported cold sensitivity, and the disabilities of arm, shoulder, and hand (DASH) questionnaire to analyze functional disability. Abnormal cold intolerance was defined as a CISS score over 30. Further analysis included evaluation of epidemiologic, clinical, and perioperative data for factors predisposing to abnormal cold intolerance. RESULTS: A total of 87 patients with previous repair of upper limb arterial injuries were eligible to answer the CISS and DASH questionnaires, and 56 patients (64%; 43 men; median age: 31.9 years) completed both. In our cohort, blunt trauma was the predominant cause of injury (n = 50; 89%). Accompanying lesions of nerves (n = 22; 39%) and/or orthopedic injuries (n = 36; 64%) were present in 48 patients (86%). After a median follow-up period of 5.5 years (range, 0.5-19.7), 23 patients (41% of 56) reported on abnormal cold intolerance. Patients with cold intolerance had worse functional results (as measured by the DASH questionnaire; mean ± SD, 42.7 ± 29.7 vs 11.5 ± 23.9; P < .001) when compared with patients without. Cold intolerance was more frequently seen in patients with previous nerve lesion (P = .027) and in proximal injuries (subclavian or axillary vs brachial or forearm arteries: P = .006), but was not correlated to gender, age, involvement of the dominant or nondominant arm, and the presence of ischemia, bone injury, or an isolated vascular injury. CONCLUSIONS: Abnormal cold intolerance is frequently seen in patients with a history of arterial repair in upper limb trauma. It is associated with significant functional impairment. Concomitant nerve injury and involvement of the subclavian or axillary artery are the major predisposing factors for development of cold intolerance after upper limb trauma.