Efficacy and durability of autogenous saphenous vein conduits for lower extremity arterial reconstructions in preadolescent children (original) (raw)

Abstract

Patient population. Fourteen children (10 boys and 4 girls) aged 2 to 11 years (mean, 7.3 years) underwent 16 lower extremity vascular bypass graft procedures with saphenous vein at the University of Michigan from 1974 to 1998 (Table I). No patients were lost to followup, and all patients but one underwent repeat noninvasive studies that focused on dimensions of the vein graft, extremity blood pressures, and limb lengths. This study was approved by the University of Michigan Medical School Institutional Review Board for Human Subject Research. Vascular occlusions were due to prior cardiac catheterization (11), arteritis (1), dialysis cannulation (1), and penetrating trauma (1). The mean interval between injury and operation was 5.7 years (range, immediate to 11.4 years). If one excludes the patient with arteritis because the time of onset of his disease could not be identified, the delay in operation was 6.5 years. Operative indications included LLD (6), claudication (4), both LLD and claudication (3), concern for potential development of LLD (2), and obvious vascular trauma with hemorrhage (1). Four patients were noted in two earlier publications from the authors' institution. 5,6 Lower extremity arterial reconstructions in growing children are uncommon; most are performed for iatrogenic trauma from femoral artery catheterization. 1-6 Such an injury, untreated, has the potential to lead to growth retardation and limb length discrepancy (LLD). 4,7-11 Reversed autogenous saphenous vein bypass grafts in the lower extremities of pediatric patients are a matter of concern because of documented aneurysmal changes of vein grafts used for vascular reconstructions in other arterial beds. 12-14 This concern was the impetus to investigate the efficacy and durability of saphenous vein used for lower extremity revascularizations in children.

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