Reconstruction of veins: the need for objectivity.

The reconstruction of veins is gradually gaining acceptance as a valuable surgical tool in alleviating or ameliorating the disability of venous occlusion in both trauma and post-thrombotic conditions. A study of 169 consecutive cases of venous reconstruction on the vascular service was undertaken in an effort to help (1) identify candidates, (2) select the reconstructive procedure, and (3) analyze the role of the adjuvant arteriovenous fistula. One hundred nineteen procedures were performed in post-phlebitic disease, including fifteen cases of adjuvant arteriovenous fistula, 42 in patients with trauma and the remaining eight were undertaken to rectify venous obstruction resulting from extrinsic pathology. While the clinical results appear promising, objectivity in the evaluation of venous reconstruction with phlebograms and pressure studies is greatly needed before definitive conclusions can be drawn.