Brachial artery reconstruction in trauma using reversed arm vein from the injured upper limb

Abstract

Background: Brachial artery repair may be technically challenging with a paucity of guidelines. The use arm vein (AV) from the traumatized limb is herein described. Methods: Data were prospectively collected from 2002 to 2016 on brachial artery injury including age, sex, mechanism/site of injury, and repair technique. Categories included AV and non-arm vein (NAV) groups. One-year outcomes were noted. Results: All 31 cases studied were of men with an age range of 16 to 73 years (mean = 28). Injuries included 13 gunshots, 7 stabbings, 6 glass injuries, 2 dislocated elbows, 1 crush, 1 impalement, and 1 avulsion. Site of injuries included the antecubital region in 25, midbrachial in 5, and proximal brachial in 1, with 4 associated fractures. Repair was done using reversed AV from the traumatized limb in 15 cases and NAV in 16. In the AV group, the adjacent basilic vein was used in 9 cases, the adjacent cephalic vein in 3, and the distal (or wrist area) cephalic vein in 3. The limb salvage rates in the AV versus NAV groups were 100% and 94%, respectively (Fisher’s exact t test, P = 1.00), with no major technique-related complications. Conclusions: The outcomes of using reversed AV from the traumatized limb are equivalent to those of other standard techniques such as primary repair, polytetrafluoroethylene, or reversed great saphenous vein, with a 1-year limb salvage rate of 100%. Additionally, advantages include decreased wound complications, better vein graft-artery caliber match, and shorter operating times while maintaining acceptable patency rates.