Arterial segments as microvascular interposition grafts in venous anastomosis in digital replantations

ABSTRACT

Introduction: Microvascular anastomosis is a crucial procedure in replantation surgeries. Venous insufficiency is one of the most consistent cause of failure or re-exploration in these surgeries necessitating the use of venous grafts. Materials and Methods: We discuss our study of 9 such replantation surgeries executed in calendar year 2013-2014, including a double finger replantation done in the same patient having total amputation of 4 fingers of the same (right) hand, in which an arterial segment was used as a microvascular interposition graft for venous anastomosis. Out of these 9 surgeries, 3 were re-exploration procedures for venous compromise and 6 were successful primary replantations. Results: In all, 8 replants were successful and one failed due to arterial compromise. Discussion: In our experience and extensive review of the previously available literature, we would like to portray the advantages of arterial segments as microvascular grafts in replant surgeries. Specifically, in a crush amputation injury for which the use of a vascular interposition graft is being contemplated. If any other digit is also amputated and is unsuitable for replantation, it can act as a potential donor site to harvest the arterial segment. However, when dealing with single finger amputation, the surgeon must be confident about the single digital arterial anastomosis, before harvesting the second digital artery as a microvascular graft. Conclusion: In our study, we found the use of arterial grafts in microvascular anastomosis of veins advantageous, as arterial segments have better ability to resist spasm due to environmental changes, better pressure tolerance as compared to venous segments, and provide an appropriate calibre match and ease of harvest in the same operative field.

KEY WORDS

Arterial - grafts - microvascular - replantation

• REFERENCES

• 1 He GW, Angus JA, Rosenfeldt FL. Reactivity of the canine isolated internal mammary artery, saphenous vein, and coronary artery to constrictor and dilator substances: Relevance to coronary bypass graft surgery. J Cardiovasc Pharmacol 1988; 12: 12-22
• 2 van Son JA, Smedts F, Vincent JG, van Lier HJ, Kubat K. Comparative anatomic studies of various arterial conduits for myocardial revascularization. J Thorac Cardiovasc Surg 1990; 99: 703-7
• 3 Lüscher TF, Diederich D, Siebenmann R, Lehmann K, Stulz P, von Segesser L. et al. Difference between endothelium-dependent relaxation in arterial and in venous coronary bypass grafts. N Engl J Med 1988; 319: 462-7
• 4 Liu ZG, Ge ZD, He GW. Difference in endothelium-derived hyperpolarizing factor-mediated hyperpolarization and nitric oxide release between human internal mammary artery and saphenous vein. Circulation 2000; 102: III296-301
• 5 Zhang RZ, Yang Q, Yim AP, Huang Y, He GW. Different role of nitric oxide and endothelium-derived hyperpolarizing factor in endothelium-dependent hyperpolarization and relaxation in porcine coronary arterial and venous system. J Cardiovasc Pharmacol 2004; 43: 839-50
• 6 He GW, Yang CQ. Comparison among arterial grafts and coronary artery. An attempt at functional classification. J Thorac Cardiovasc Surg 1995; 109: 707-15
• 7 He GW. Arterial grafts for coronary artery bypass grafting: Biological characteristics, functional classification, and clinical choice. Ann Thorac Surg 1999; 67: 277-84
• 8 He GW, Yang CQ, Starr A. Overview of the nature of vasoconstriction in arterial grafts for coronary operations. Ann Thorac Surg 1995; 59: 676-83
• 9 He GW, Rosenfeldt FL, Buxton BF, Angus JA. Reactivity of human isolated internal mammary artery to constrictor and dilator agents. Implications for treatment of internal mammary artery spasm. Circulation 1989; 80: I141-50
• 10 Liu MH, Floten HS, Furnary AP, Yim AP, He GW. Inhibition of vasoconstriction by angiotensin receptor antagonist GR117289C in arterial grafts. Ann Thorac Surg 2000; 70: 2064-9
• 11 Wei W, Floten HS, He GW. Interaction between vasodilators and vasopressin in internal mammary artery and clinical significance. Ann Thorac Surg 2002; 73: 516-22
• 12 Luu TN, Dashwood MR, Chester AH, Tadjkarimi S, Yacoub MH. Action of vasoactive intestinal peptide and distribution of its binding sites in vessels used for coronary artery bypass grafts. Am J Cardiol 1993; 71: 1278-82
• 13 Chen ZW, Yang Q, Huang Y, Fan L, Li XW, He GW. Human urotensin II in internal mammary and radial arteries of patients undergoing coronary surgery. Vascul Pharmacol 2010; 52: 70-6
• 14 Bai XY, Liu XC, Yang Q, Tang XD, He GW. The interaction between human urotensin II and vasodilator agents in human internal mammary artery with possible clinical implications. Ann Thorac Surg 2011; 92: 610-6
• 15 He GW, Yang CQ. Radial artery has higher receptor-mediated contractility but similar endothelial function compared with mammary artery. Ann Thorac Surg 1997; 63: 1346-52
• 16 He GW, Shaw J, Hughes CF, Yang CQ, Thomson DS, McCaughan B. et al. Predominant alpha 1-adrenoceptor-mediated contraction in the human internal mammary artery. J Cardiovasc Pharmacol 1993; 21: 256-63
• 17 He GW, Yang CQ. Characteristics of adrenoceptors in the human radial artery: Clinical implications. J Thorac Cardiovasc Surg 1998; 115: 1136-41
• 18 Seo B, Oemar BS, Siebenmann R, von Segesser L, Lüscher TF. Both ETA and ETB receptors mediate contraction to endothelin-1 in human blood vessels. Circulation 1994; 89: 1203-8
• 19 Yildiz O, Ciçek S, Ay I, Tatar H, Tuncer M. 5-HT1-like receptor-mediated contraction in the human internal mammary artery. J Cardiovasc Pharmacol 1996; 28: 6-10
• 20 He GW, Yang CQ. Comparison of nitroprusside and nitroglycerin in inhibition of angiotensin II and other vasoconstrictor-mediated contraction in human coronary bypass conduits. Br J Clin Pharmacol 1997; 44: 361-7
• 21 He GW, Yang CQ. Effect of thromboxane A2 antagonist GR32191B on prostanoid and nonprostanoid receptors in the human internal mammary artery. J Cardiovasc Pharmacol 1995; 26: 13-9
• 22 Liu JJ, Phillips PA, Burrell LM, Buxton BB, Johnston CI. Human internal mammary artery responses to non-peptide vasopressin antagonists. Clin Exp Pharmacol Physiol 1994; 21: 121-4
• 23 Ochiai M, Ohno M, Taguchi J, Hara K, Suma H, Isshiki T. et al. Responses of human gastroepiploic arteries to vasoactive substances: Comparison with responses of internal mammary arteries and saphenous veins. J Thorac Cardiovasc Surg 1992; 104: 453-8
• 24 Mügge A, Barton MR, Cremer J, Frombach R, Lichtlen PR. Different vascular reactivity of human internal mammary and inferior epigastric arteries in vitro . Ann Thorac Surg 1993; 56: 1085-9
• 25 Valnicek SM, Mosher M, Hopkins JK, Rockwell WB. The subscapular arterial tree as a source of microvascular arterial grafts. Plast Reconstr Surg 2004; 113: 2001-5
• 26 Arnez ZM, Lister GD. The posterior interosseous arterial graft. Plast Reconstr Surg 1994; 94: 202-6
• 27 Lee BI, Chung HY, Kim WK, Kim SW, Dhong ES. The effects of the number and ratio of repaired arteries and veins on the survival rate in digital replantation. Ann Plast Surg 2000; 44: 288-94