Abstract
The management of patients with vascular trauma continues to evolve. However, many of the core principles continue to be based on historical dogma rather than evidence-based medicine. Indications for fasciotomy, the role of periprocedural anticoagulation and the tolerability of deep venous ligation are just a few examples of areas where surgical trainees are taught a strict set of “rules” to guide decision-making. Always do fasciotomies after 6 hours of ischemia, never systemically anticoagulate a trauma patient, never ligate the popliteal vein—none of these recommendations are based on high-quality evidence.
Here, Drs Reddy and Rowe challenge the dogmatic recommendation that saphenous vein should always be harvested from the contralateral leg during arterial reconstruction of lower extremity trauma. Their treatise highlights the importance of common sense when faced with a shortage of compelling, high-quality data. In selected cases, ipsilateral harvest is safe, expeditious, and advantageous. Thankfully, the literature surrounding the management of vascular trauma continues to improve. Programs such as the PROspective Observational Vascular Injury Trial 1 are now providing us with large, prospective, data-driven means of answering these questions. Such endeavors will eventually allow us to substitute sometimes for our current always and never.
