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J Reconstr Microsurg 2024; 40(05): 329-333
DOI: 10.1055/s-0043-1776735
Original Article

Comparison of Arterial and Venous Interposition Grafting for Arterial Defects in a Rat Model

Brahman Sivakumar
1   Australian Research Collaboration on Hands (ARCH), Mudgeeraba, Australia
2   Discipline of Surgery, Sydney Medical School, the Faculty of Medicine and Health, the University of Sydney, Camperdown, NSW, Australia
3   Department of Orthopaedic Surgery, Northern Beaches Hospital, Frenchs Forest, NSW, Australia
4   Department of Orthopaedic Surgery, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia
5   Department of Orthopaedic Surgery, Nepean Hospital, Kingswood, NSW, Australia
,
Keely Thatcher
6   Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia
,
Ian Hughes
7   School of Medicine, University of Queensland, Herston, QLD, Australia
8   Office for Research Governance and Development, Gold Coast Health, Southport, QLD, Australia
,
Anna Watson
3   Department of Orthopaedic Surgery, Northern Beaches Hospital, Frenchs Forest, NSW, Australia
,
Bernard Schick
9   Department of Hand Surgery, Sydney Hospital, Sydney Hospital Hand Unit, Sydney, NSW, Australia
,
David J. Graham
1   Australian Research Collaboration on Hands (ARCH), Mudgeeraba, Australia
7   School of Medicine, University of Queensland, Herston, QLD, Australia
10   Department of Musculoskeletal Services, Gold Coast University Hospital, Southport, QLD, Australia
11   School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia
12   Department of Orthopaedic Surgery, Queensland Children's Hospital, South Brisbane, QLD, Australia
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Funding This study was funded by the Australian Hand Surgery Society ($7000) and NSW Hand Surgery Society ($1670).
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Abstract

Background Interposition microvascular grafting may be required to bridge arterial defects during digital replantation or revascularization and has traditionally been performed utilizing a venous autograft. Arterial interposition grafting has been shown to be superior in maintaining patency in large vessel surgery; there are case reports of its use in microsurgery.

Methods Six fellowship-trained hand and microsurgeons performed arterial and venous interposition grafts on the femoral arteries of 40 Wistar rats. After sectioning one femoral artery a segment of the contralateral femoral artery or vein was obtained. The time was recorded per graft and patency tested 10 minutes following grafting by an independent assessor. Each surgeon also completed a questionnaire detailing regular microsurgical volume, technical ease, and conceptual preference for either graft.

Results Time for arterial interposition (median time 51.7 minutes) was longer than venous grafting (median time 45.9 minutes, p = 0.075). Arterial grafts were more likely to be patent or questionably patent (odds ratio [OR] = 6.77, p = 0.031). All surgeons found arterial interposition grafting technically easier and preferred it conceptually. Improvements were noted in patency rates (OR = 11.29, p = 0.018) and avoidance of anastomotic leak (OR = 0.19, p = 0.029) when surgeons performed moderate levels or greater of microsurgery within their regular practice.

Conclusion Greater immediate patency was noted with arterial interposition grafting in a rodent model when compared to venous grafting, although procedural time was greater. All surgeons found arterial grafting technically easier. Arterial microvascular grafting may be useful in the setting of digital replantation or revascularization with an arterial defect.

Keywords

arterial repair - interposition grafting - microvascular grafting - revascularization - replantation - venous grafting


Publikationsverlauf

Eingereicht: 03. Juli 2023

Angenommen: 28. September 2023

Artikel online veröffentlicht:
27. November 2023

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