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      Comparison of venous repair results using either arterial or vein grafts in a crush-avulsion injury model

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          Abstract

          Background/aim

          Venous insufficiency after replantation or revascularization is one of the most common causes of limb loss in either the short or the long term. The aim of this study was to evaluate the results of a new technique to overcome venous insufficiency.

          Materials and Methods

          A crush-avulsion type of injury was formed in the femoral veins of rats of 3 separate groups. In the control group, primary repair was applied to the damaged veins and the remaining 2 groups were repaired with either an arterial graft or a vein graft. The success rates of anastomosis were then compared.

          Results

          In the control group the patency rate was 25% in the 2nd hour, 12.5% on the 2nd day, and 12.5% on the 10th day. The patency rate in the vein group was 87.5% in the 2nd hour, 50% on the 2nd day, and 37.5% on the 10th day, whereas the patency rates in the artery group were 100% in the 2nd hour, 87.5% on the 2nd day, and 75% on the 10th day.

          Conclusion

          Microsurgery requires experience and patience. It can be considered that the use of arterial grafts for venous repair in replantation after crush-avulsion type amputations can increase the success rate of replantation.

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          Most cited references22

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          Aortocoronary Saphenous Vein Graft Disease: Pathogenesis, Predisposition, and Prevention

          Aortocoronary saphenous vein graft disease, with its increasing clinical sequelae, presents an important and unresolved dilemma in cardiological practice. During the 1st month after bypass surgery, vein graft attrition results from thrombotic occlusion, while later the dominant process is atherosclerotic obstruction occurring on a foundation of neointimal hyperplasia. Although the risk factors predisposing to vein graft atherosclerosis are broadly similar to those recognized for native coronary disease, the pathogenic effects of these risk factors are amplified by inherent deficiencies of the vein as a conduit when transposed into the coronary arterial circulation. A multifaceted strategy aimed at prevention of vein graft disease is emerging, elements of which include: continued improvements in surgical technique; more effective antiplatelet drugs; increasingly intensive risk factor modification, in particular early and aggressive lipid-lowering drug therapy; and a number of evolving therapies, such as gene transfer and nitric oxide donor administration, which target vein graft disease at an early and fundamental level. At present, a key measure is to circumvent the problem of vein graft disease by preferential selection of arterial conduits, in particular the internal mammary arteries, for coronary bypass surgery whenever possible.
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            Difference between endothelium-dependent relaxation in arterial and in venous coronary bypass grafts.

            Both the internal mammary artery and the saphenous vein are used to construct coronary-artery bypass grafts. We hypothesized that the release or production of endothelium-derived relaxing factor, which regulates blood flow and inhibits platelet function, may differ in venous and arterial grafts. We therefore studied endothelium-dependent relaxation in internal mammary arteries, internal mammary veins, and saphenous veins obtained from 58 patients undergoing coronary bypass surgery. Vascular rings with and without endothelium were suspended in organ chambers, and isometric tension was recorded. Acetylcholine (10(-8) to 10(-4) M), thrombin (1 U per milliliter), and adenosine diphosphate (10(-7) to 10(-4) M) evoked potent endothelium-dependent relaxation in the mammary artery but weak response in the saphenous vein (P less than 0.005; n = 6 to 27). In the mammary artery, relaxation was greatest in response to acetylcholine (86 +/- 4 percent reduction in norepinephrine-induced tension), followed by thrombin (44 +/- 7 percent) and adenosine diphosphate (39 +/- 8 percent). In the saphenous and mammary veins, relaxation was less than 25 percent. Relaxation was unaffected by indomethacin but was inhibited by methylene blue and hemoglobin (P less than 0.005 and 0.01, respectively), which suggests that endothelium-derived relaxing factor was the mediator. Endothelium-independent relaxation in response to sodium nitroprusside was similar in arteries and veins. We conclude that endothelium-dependent relaxation is greater in the mammary artery than in the saphenous vein. The possibility that this contributes to the higher patency rate among arterial grafts than among venous grafts will require further study.
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              Twenty years' experience of limb replantation--review of 293 upper extremity replants.

              S Tamai (1982)
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                Author and article information

                Journal
                Turk J Med Sci
                Turk J Med Sci
                Turkish Journal of Medical Sciences
                The Scientific and Technological Research Council of Turkey
                1300-0144
                1303-6165
                2019
                11 February 2019
                : 49
                : 1
                : 435-441
                Affiliations
                [1 ] Department of Plastic, Reconstructive, and Aesthetic Surgery, University of Health Sciences Şişli Hamidiye Etfal Research and Training Hospital, İstanbul Turkey
                [2 ] Department of Plastic Surgery, Balıkesir State Hospital, Balıkesir Turkey
                [3 ] Department of Pathology, University of Health Sciences Şişli Hamidiye Etfal Research and Training Hospital, İstanbul Turkey
                Author notes
                * To whom correspondence should be addressed. E-mail: isilakgundemir@ 123456gmail.com

                CONFLICT OF INTEREST:

                none declared

                Author information
                https://orcid.org/0000-0003-4338-9610
                https://orcid.org/ 0000-0003-2047-9779
                https://orcid.org/0000-0002-5842-8195
                https://orcid.org/0000-0002-2523-9195
                https://orcid.org/0000-0002-9625-6670
                https://orcid.org/0000-0003-2343-1236
                https://orcid.org/0000-0003-0908-1719
                Article
                10.3906/sag-1808-38
                7350846
                30761834
                101fe856-0335-426a-9772-fc4047bd7829
                Copyright © 2019 The Author(s)

                This article is distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use and redistribution provided that the original author and source are credited.

                History
                Categories
                Article

                microsurgery, replantation, amputation, arterial graft

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