Emergency War Surgery NATO Handbook: Part III: General Considerations of Wound Management: Chapter XVIII: Vascular Injuries

Choice of Conduit

United States Department of Defense

When major arteries or veins require patching or replacement, the surgeon must decide which patch material or conduit to utilize Conventional wisdom is that the greater saphenous vein is the material of choice It should be harvested from the uninjured extremity whenever possible to avoid compromising venous outflow from the injured extremity and wound healing problems should an arterial repair fail and result in marginal ischemia. When the greater saphenous vein is not available, the lesser saphenous vein is the next best choice, as its histology is similar to that of the greater saphenous vein. Upper extremity veins are another available source of patch material or conduit, but have thinner walls and are thus more prone to degeneration and aneurysm formation. Neck veins should not be used because they are too thin walled to withstand arterial pressure In the trauma setting, autogenous arteries and synthetic conduits should be used only under extreme circumstances, when no other vascular substitute is available. Synthetic conduits of all types are prone to infection. In the rare event that a synthetic conduit is needed, poly-tetrafluoroethylene (PTFE) is preferable to Dacron, as it appears to have a better chance of resisting and withstanding infection.

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Operational Medicine 2001

Health Care in Military Settings

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