When a segment of artery is destroyed, something has to bridge the gap. A length of the patient's own vein, reversed so its valves do not obstruct flow, is the most reliable material available for the limbs.
A vein graft repair bridges a missing segment of artery using a length of the patient's own vein, usually the great saphenous vein from the leg. The vein is reversed so its one way valves do not block arterial flow, then sewn to healthy artery at both ends. Vein resists infection and stays open better than synthetic material in limb arteries, which is why it is preferred in trauma and below the knee.
An artery that has been crushed, shot or torn usually loses a segment. Trimming back to healthy wall on both sides leaves a gap that cannot be closed by pulling the ends together without putting the repair under tension, and a tense repair fails.
Something must bridge the gap. Synthetic tubes work well in large, high flow vessels such as the aorta. In the limbs they perform less well: flow is slower, the vessels are smaller, and the graft crosses joints where it is repeatedly bent. Most importantly, synthetic material in a contaminated wound becomes infected and, once infected, almost always has to be removed.
Vein solves all of that. It is living tissue with its own blood supply in its wall, so it resists infection in a way plastic never will. It handles small calibre joins better, and it tolerates bending. The one adjustment needed is reversal: veins contain valves that allow flow in one direction only, so the segment is turned end for end before it is sewn in, and the valves then open with arterial flow instead of blocking it.
The donor leg manages without the vein. The deep veins carry the great majority of the return, and where the great saphenous vein is unavailable, an arm vein or a segment of small saphenous vein can be used instead.
The limiting factor is usually whether a vein of adequate size and quality is available, which is checked before the operation where circumstances allow.
The great saphenous vein is examined, and scanned where time allows, to confirm it is of adequate diameter and free of disease.
The required length is removed through one long or several short incisions, and its side branches tied off.
The vein is gently distended to check for leaks and turned end for end so its valves will not obstruct arterial flow.
The graft is sewn onto healthy artery above the defect with fine sutures, often under magnification.
The graft is passed along the natural line of the artery and joined below, taking care that it is neither kinked nor twisted.
Clamps are released and flow confirmed by pulse, Doppler or direct measurement before the wound is closed and covered.
Circulation beyond the graft is checked frequently. This is when technical problems show themselves and can often be corrected.
Wounds at both the graft and donor sites are monitored. Mobilisation begins. Donor leg swelling is common and settles with elevation.
Wounds heal. Baseline surveillance scan is usually performed. Rehabilitation continues for the underlying injury.
Surveillance scanning continues at intervals. Antiplatelet medication continues indefinitely in most cases.
A vein graft in a limb artery gives the best long term patency currently available, but no graft lasts indefinitely. Narrowing develops at the joins and within the graft over years, which is why surveillance scanning matters: a narrowing can be corrected, a fully blocked graft usually cannot. The donor leg has an extra scar and occasionally some numbness along it, and where the saphenous vein has been removed some patients notice mild ankle swelling. In trauma, the graft may be one part of a reconstruction that also involves bone, nerve and soft tissue, and overall function depends on all of them.
Risks divide into those of the graft itself and those of the leg the vein was taken from.
What keeps a vein graft open is mostly medical rather than surgical.
The deep veins carry the great majority of the blood out of the leg and continue to do so. The saphenous vein is removed routinely for this purpose and for heart bypass surgery without long term harm to most patients.
Stronger, but not better. In limb arteries synthetic grafts block more often, and in a contaminated wound they become infected and usually have to be removed.
Veins contain one way valves. Used the wrong way round they would obstruct arterial flow completely. Reversal is essential, not a refinement.
A narrowing graft usually causes no symptoms until it blocks. Once blocked it often cannot be saved. That is precisely why surveillance exists.
Microsurgical training makes small calibre vein grafting practical rather than theoretical, and the same team can cover the repair with healthy tissue, which is what protects it in a contaminated wound.
Usually part of emergency trauma care or of bypass surgery, and covered on the same basis by health insurance and government schemes including PM JAY. A written estimate follows assessment.
Mostly asked about the leg the vein came from.
Ask your question →Almost always no. The deep veins do most of the work of draining the leg. Some patients notice mild ankle swelling or a patch of numbness along the scar, and both usually settle.
Veins have one way valves that normally stop blood falling back down the leg. Used in the same orientation in an artery, those valves would face the wrong way and block the flow completely, so the segment is reversed.
An arm vein or the small saphenous vein from the calf can often be used instead. If no vein is available, a synthetic graft is used, accepting that it needs closer surveillance and is more vulnerable to infection.
Many years in favourable circumstances, and surveillance is what protects that. Grafts narrow gradually, and a narrowing found on a scan can usually be repaired. One found only after the graft has blocked frequently cannot.
It is much less likely than with synthetic material, which is the main reason vein is chosen in dirty wounds. Report any redness, swelling or discharge over the graft promptly.
Seeing patients from across the city and beyond: read about the practice on the plastic surgeon in Surat page, or check what a written estimate covers on the costs and insurance page.
