Mikrovasküler rekonstrüksiyonlarda ven grefti kaynağı olarak kullanılan üst ekstremite yüzeysel venlerinin anatomik özellikleri: Kadavra çalışması

Öz

Amaç: Bu çalışmada üst ekstremite arterlerine uygun olabilecek ven greft kaynakları ve bu venlerin özelliklerinin araştırılması planlandı. Çalışma planı: Sekiz kadavranın 16 üst ekstremitesi araştırıldı. Üst ekstremitenin yüzeysel venlerinin anatomik lokalizasyonu, çapları, duvar kalınlıkları ve kapak tipleri sayıldı ve değerlendirildi. Bulgular: Brakiyal arterin ortalama çapı 3.96 mm, radyal arterin ortalama çapı 2.54 mm, ulnar arterin ortalama çapı 2.12 mm, palmar dijital arter 3’ün ortalama çapı 0.85 mm, sefalik venin ortalama çapı 1.81 mm, bazilik venin ortalama çapı 3.20 mm, ön kol sefalik venin ortalama çapı 2.04 mm, ön kol bazilik venin ortalama çapı 1.35 mm, elin sırtındaki venöz ağın ortalama çapı 1.27 mm olarak ölçüldü. Üç farklı tip kapak tanımlandı. Tip 3 kapak, sefalik ven (%86.5) ve bazilik ven (%90.7) boyunca en sık görülen kapak tipiydi. Çıkarımlar: Çalışmamızda üst ekstremite yüzeysel venleri ile ilgili elde ettiğimiz verilerin, mikrocerrahi rekonstrüksiyonlarında cerrahlara yardımcı olabileceğini düşünüyoruz.

Anahtar Kelimeler

• Greft kaynağı; üst ekstremite; venöz kapak; yüzeysel ven.

Anatomical evaluation of the superficial veins of the upper extremity as graft donor source in microvascular reconstructions: a cadaveric study

Abstract

Objective: The aim of study was to investigate the features and resources for vein grafts suitable for upper extremity arteries.
Methods: Sixteen upper extremities of 8 cadavers were investigated. Anatomic localizations, diameters, wall thickness and valve types of the superficial veins of the upper extremity were counted and evaluated.
Results: Average diameter of the brachial artery was 3.96 mm, the radial artery 2.54 mm, the ulnar artery 2.12 mm, the proper palmar digital artery 3 0.85 mm, the cephalic vein of the arm 1.81 mm, the basilic vein of the arm 3.20 mm, the cephalic vein of the forearm 2.04 mm, the basilic vein of the forearm 1.35 mm, and the dorsal venous network of the hand 1.27 mm. Three different types of valves were determined. The most frequent valve types were the Type 3 in the cephalic and basilica veins at 86.5% and 90.7%, respectively.
Conclusion: Data obtained on the superficial veins of the upper extremity may be helpful to surgeons in microsurgical reconstructions. 

Keywords

• Cutaneous vein
• graft source
• upper limb
• venous valve

References

1. Bacako¤lu A, Ozkan MH, Göktay AY, Ekin A. Forearm arterial vein grafting: problems and alternative solutions. J Int Med Res 2003;31:458-65.
2. Bazan HA, Schanzer H. Transposition of the brachial vein: a new source for autologous arteriovenous fistulas. J Vasc Surg 2004;40:184- 6.
3. Browning N, Zammit M, Rodriguez D, Sauvage L, Loudenback D, Raghavan A. Use of arm veins for lower extremity arterial bypass – results, anatomical features and technical considerations. S Afr J Surg 2000;38:36-41.
4. Clayson KR, Edwards WH, Allen TR, Dale A. Arm veins for peripheral arterial reconstruction. Arch Surg 1976;111: 1276Faries PL, Logerfo FW, Arora S, Pulling MC, Rohan DI, Akbari CM, et al. Arm vein conduit is superior to composite prosthetic-autogenous grafts in lower extremity revascularization. J Vasc Surg 2000;31:1119-27.
5. Grigg MJ, Wolfe JH. Combination reversed and nonreversed upper arm vein for femoro-distal grafting. Eur J Vasc Surg 1988;2:49-52.
6. Hallock GG. Macrovascular surgery and the microsurgeon. J Reconstr Microsurg 1997;13:563-70.
7. Hölzenbein TJ, Pomposelli FB Jr, Miller A, Gibbons GW, Campbell DR, Freeman DV, et al. Results of a policy with arm veins used as the first alternative to an unavailable ipsilateral greater saphenous vein for infrainguinal bypass. J Vasc Surg 1996;23:130-40.
8. Nehler MR, Dalman RL, Harris EJ, Taylor LM Jr, Porter JM. Upper extremity arterial bypass distal to the wrist. J Vasc Surg 1992;16:633-42.

9. Vlastou C, Earle AS, Jordan R. Vein grafts in reconstructive microsurgery of the lower extremity. Microsurgery 1992;13: 234Iimura A, Nakamura Y, Itoh M. Anatomical study of distribution of valves of the cutaneous veins of adult's limbs. Ann Anat 2003;185:91-5.
10. Berger A, Brenner P, Flory P, Schaller E, Schneider W. Progress in limb and digital replantation: Part B. World J Surg 1990;14:807-18.
11. Hallock GG. Venae comitantes as a source of vein grafts. J Reconstr Microsurg 2007;23:219-23.
12. Schlenker JD, Schraut W. Autologous vein transplants for digital revascularization after hand injuries. [Article in German] Handchirurgie 1981;13:131-7.
13. Sukop A, Tvrdek M, Kufa R. The primary use of venous grafts in thumb replantation. Acta Chir Plast 2005;47:103-6. Le Saout J, Vallee B, Person H, Doutriaux M, Blanc J, Nguyen H. Anatomical basis for the surgical use of the cephalic vein (V. cephalica). 74 anatomical dissections. 189 surgical dissections. [Article in French] J Chir (Paris) 1983; 120:131-4.
14. Kiliç S, Bacako¤lu AK, Göktay AY, Ozkan MH, Ergör G, Bayatli K, et al. Evaluation of flow hemodynamics by colorDoppler following two different brachial arterial repair techniques. Eur J Vasc Endovasc Surg 2004;28:310-6.