Short-Term Results of an Algorithm for Brachial Artery Injury Repair Favoring a Reversed Ipsilateral Arm Vein Conduit.

BACKGROUND

The great saphenous vein (GSV) has been the traditional conduit for repair of brachial artery injury that is not amenable to primary anastomosis. The use of the ipsilateral upper limb cephalic or basilic vein can preserve the saphenous vein and avoid an extra incision. However, there is a lack of robust data on long-term outcomes. The aim of this study was to evaluate the feasibility, complications, patency rates, and limb salvage rates associated with this technique.

METHODS

A prospective cohort study was conducted on 52 patients with brachial artery injury requiring interposition graft repair. A predetermined algorithm was followed, aiming to use the ipsilateral superficial arm vein as a conduit, with preservation of at least one superficial arm vein for venous drainage whenever feasible.

RESULTS

The use of ipsilateral superficial arm vein graft was achievable in 71.2% of the patients. Transient arm edema occurred in 32.7% of the patients. At 1 year, the primary and secondary patency rates were 84.6% and 88.5%, respectively, with an overall limb salvage rate of 100%. A significantly higher number of gunshot injuries was noted in the GSV group as compared to the arm vein group, as well as significantly longer operative times and more fasciotomies. No significant difference was detected in patency and complication rates. Also, no significant difference was observed between the noninjured and injured arm vein in terms of complications and patency rates.

CONCLUSION

Repair of injured brachial artery can be successfully achieved using the superficial arm vein in most of the patients with similar complication and patency rates as the GSV. Patients with complex and gunshot injuries are more likely to require a GSV graft. Using an injured arm vein is feasible and suitable, especially in penetrating trauma.