Download PDF
CC BY-NC-ND 4.0 · Arch Plast Surg 2022; 49(04): 543-548
DOI: 10.1055/s-0042-1744424
Extremity/Lymphedema
Review Article

The Use of Arteriovenous Bundle Interposition Grafts in Microsurgical Reconstruction: A Systematic Review of the Literature

Aurora M. Kareh
1   Division of Plastic and Reconstructive Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
,
Kashyap Komarraju Tadisina
1   Division of Plastic and Reconstructive Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
,
Magnus Chun
2   Tulane University School of Medicine, New Orleans, Louisiana
,
Sumesh Kaswan
1   Division of Plastic and Reconstructive Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
,
Kyle Y. Xu
3   Division of Plastic Surgery, University of Miami Miller School of Medicine, Miami, Florida
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Microvascular reconstruction frequently requires anastomosis outside of the zone of injury for successful reconstruction. Multiple options exist for pedicle lengthening including vein grafts, arteriovenous loops, and arteriovenous bundle interposition grafts. The authors performed a systematic review of arteriovenous bundle interposition grafts to elucidate indications and outcomes of arteriovenous grafts in microvascular reconstruction. A systematic review of the literature was performed using targeted keywords. Data extraction was performed by two independent authors, and descriptive statistics were used to analyze pooled data. Forty-four patients underwent pedicle lengthening with an arteriovenous graft from the descending branch of the lateral circumflex femoral artery. Most common indications for flap reconstruction were malignancy (n = 12), trauma (n = 7), and diabetic ulceration (n = 4). The most commonly used free flap was the anterolateral thigh flap (n = 18). There were five complications, with one resulting in flap loss. Arteriovenous bundle interposition grafts are a viable option for pedicle lengthening when free flap distant anastomosis is required. The descending branch of the lateral circumflex femoral artery may be used for a variety of defects and can be used in conjunction with fasciocutaneous, osteocutaneous, muscle, and chimeric free flaps.

Keywords

arteriovenous bundle interposition grafts - pedicle lengthening - arteriovenous loop - arteriovenous grafts

Author Contributions

All authors listed were involved equally in conceiving and designing the study, data collection and analysis, and manuscript writing and editing.




Publication History

Article published online:
30 July 2022

© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Di Taranto G, Chen SH, Elia R. et al. Outcomes following head neck free flap reconstruction requiring interposition vein graft or vascular bridge flap. Head Neck 2019; 41 (09) 2914-2920
    CrossrefPubMedSearch in Google Scholar
  • 2 Maricevich M, Lin LO, Liu J, Chang EI, Hanasono MM. Interposition vein grafting in head and neck free flap reconstruction. Plast Reconstr Surg 2018; 142 (04) 1025-1034
    CrossrefPubMedSearch in Google Scholar
  • 3 Inbal A, Silva AK, Humphries LS, Teven CM, Gottlieb LJ. Bridging the gap: a 20-year experience with vein grafts for free flap reconstruction. The odds for success. Plast Reconstr Surg 2018; 142 (03) 786-794
    CrossrefPubMedSearch in Google Scholar
  • 4 Lee ZH, Alfonso AR, Stranix JT. et al. Vein size mismatch increases flap failure in lower extremity trauma free flap reconstruction. J Reconstr Microsurg 2019; 35 (08) 587-593
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Zenn MR, Pribaz J, Walsh M. Use of the descending lateral femoral circumflex artery and vein for vascular grafting: a better alternative to an arteriovenous loop. Plast Reconstr Surg 2010; 126 (01) 140-142
    CrossrefPubMedSearch in Google Scholar
  • 6 Kim YH, Kim JW, Kim TG, Lee JH, Chung KJ, Yeo CH. Ischemic time in free-flap surgery with arteriovenous bundle interposition graft: comparison of two anastomosis sequences. J Craniofac Surg 2019; 30 (02) 493-496
    CrossrefPubMedSearch in Google Scholar
  • 7 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009; 151 (04) 264-269
    CrossrefPubMedSearch in Google Scholar
  • 8 Park JH, Min KH, Eun SC, Lee JH, Hong SH, Kim CW. Scalp free flap reconstruction using anterolateral thigh flap pedicle for interposition artery and vein grafts. Arch Plast Surg 2012; 39 (01) 55-58
    Thieme ConnectPubMedSearch in Google Scholar
  • 9 Godina M. Arterial autografts in microvascular surgery. Plast Reconstr Surg 1986; 78 (03) 293-294
    CrossrefPubMedSearch in Google Scholar
  • 10 Fabbrocini M, Fattouch K, Camporini G. et al. The descending branch of lateral femoral circumflex artery in arterial CABG: early and midterm results. Ann Thorac Surg 2003; 75 (06) 1836-1841
    CrossrefPubMedSearch in Google Scholar
  • 11 Suma H. Arterial grafts in coronary bypass surgery. Ann Thorac Cardiovasc Surg 1999; 5 (03) 141-145
    PubMedSearch in Google Scholar
  • 12 Lobay GW, Moysa GL. Primary neurovascular bundle transfer in the management of avulsed thumbs. J Hand Surg Am 1981; 6 (01) 31-34
    CrossrefPubMedSearch in Google Scholar
  • 13 Doi K. Replantation of an avulsed thumb, with application of a neuro-vascular pedicle. Hand 1976; 8 (03) 258-260
    CrossrefPubMedSearch in Google Scholar
  • 14 Bianchi B, Copelli C, Ferrari S, Ferri A, Sesenna E. Anterolateral thigh flap pedicle for interposition artery and vein grafts in head and neck reconstruction: a case report. Microsurgery 2009; 29 (02) 136-137
    CrossrefPubMedSearch in Google Scholar
  • 15 Sano K, Okuda T, Aoki R, Kimura K, Ozeki S. Usefulness of vascular bundle interposition of the descending branch of the lateral circumflex femoral vessels for free flap reconstruction of the calvarial defect. Microsurgery 2008; 28 (07) 551-554
    CrossrefPubMedSearch in Google Scholar
  • 16 Lakhiani C, Lee MR, Saint-Cyr M. Vascular anatomy of the anterolateral thigh flap: a systematic review. Plast Reconstr Surg 2012; 130 (06) 1254-1268
    CrossrefPubMedSearch in Google Scholar
  • 17 Frommer SA, Teal LN, Myers RP, Kelley PK, Henry SL. Extending the reach of craniofacial free flaps using the descending branch of the lateral circumflex femoral vessels. Plast Reconstr Surg 2021; 147 (02) 260e-264e
    CrossrefPubMedSearch in Google Scholar
  • 18 Fukuda H, Ashida M, Ishii R, Abe S, Ibukuro K. Anatomical variants of the lateral femoral circumflex artery: an angiographic study. Surg Radiol Anat 2005; 27 (03) 260-264
    CrossrefPubMedSearch in Google Scholar
  • 19 Halvorson EG, Taylor HOB, Orgill DP. Patency of the descending branch of the lateral circumflex femoral artery in patients with vascular disease. Plast Reconstr Surg 2008; 121 (01) 121-129
    CrossrefPubMedSearch in Google Scholar
  • 20 Yamashita Y, Fukuda S, Kigawa I, Wanibuchi Y. Preoperative angiographic evaluation of the descending branch of the lateral femoral circumflex artery as a free graft in coronary artery bypass graft. Jpn J Thorac Cardiovasc Surg 2005; 53 (09) 477-480
    CrossrefPubMedSearch in Google Scholar
  • 21 Lokmic Z, Stillaert F, Morrison WA, Thompson EW, Mitchell GM. An arteriovenous loop in a protected space generates a permanent, highly vascular, tissue-engineered construct. FASEB J 2007; 21 (02) 511-522
    CrossrefPubMedSearch in Google Scholar
  • 22 Yim S, Eun SC. Chondrocutaneous preauricular free flap for reconstruction of nasal defects aided by interposition vascular graft. J Craniofac Surg 2017; 28 (07) 1842-1846
    CrossrefPubMedSearch in Google Scholar
  • 23 Han HH, Choi EJ, Oh DY, Moon SH. The usefulness of microsurgical pedicle lengthening in free anterolateral thigh flaps. Microsurgery 2016; 36 (07) 559-566
    CrossrefPubMedSearch in Google Scholar
  • 24 Han HH, Jun D, Mun GH, Moon SH. Modification of pedicle lengthening through perforator transposition in free anterolateral thigh flaps with pedicle size discrepancy: A case report. Microsurgery 2018; 38 (01) 94-97
    CrossrefPubMedSearch in Google Scholar
  • 25 Lim J, Kwon H, Lee KM, Pak C. Immediate lower extremity reconstruction using an anterolateral thigh free flap with simultaneous interposition graft of descending branches of lateral circumflex femoral vessels. Int J Low Extrem Wounds 2019; 18 (01) 89-93
    CrossrefPubMedSearch in Google Scholar
  • 26 Simmons SP, Tobias B, Lichtman DM. Lunate revascularization with artery implantation and bone grafting. J Hand Surg Am 2009; 34 (01) 155-160
    CrossrefPubMedSearch in Google Scholar
  • 27 Maitz PK, Pribaz JJ, Duffy FJ, Hergrueter CA. The value of the delay phenomenon in flap prefabrication: an experimental study in rabbits. Br J Plast Surg 1994; 47 (03) 149-154
    CrossrefPubMedSearch in Google Scholar
  • 28 Pribaz JJ, Fine N, Orgill DP. Flap prefabrication in the head and neck: a 10-year experience. Plast Reconstr Surg 1999; 103 (03) 808-820
    CrossrefPubMedSearch in Google Scholar
  • 29 Hori Y, Tamai S, Okuda H, Sakamoto H, Takita T, Masuhara K. Blood vessel transplantation to bone. J Hand Surg Am 1979; 4 (01) 23-33
    CrossrefPubMedSearch in Google Scholar