Microvascular Anastomosis of Calcified Vessels in a Patient with Hyperlipidemia: Meeting the Challenges and Dealing with Y -Shaped Vein Graft.

Abstract

Hyperlipidemia is one of the causes of atherosclerotic calcified vessels. Anastomosis of such vessels during surgery may offer various challenges. It is twice as challenging when the limb's and flap's vascularity is compromised together. We present a case of microvascular anastomosis of calcified vessels with compromised limb vascularity (due to an inadvertent injury to the brachial artery, which created a gap between two ends) and low ischemia time for flap (free functioning muscle transfer) that dealt with a Y -shaped vein graft. Using a Y -shaped vein graft in atherosclerotic vessels allowed us to anastomosis with ease and deal with challenges encountered during anastomosis. The Y -shaped vein graft was used to reconstruct the brachial artery and at the same time, another limb of the Y -shaped vein graft was used to anastomose the flap's vessel. Postoperatively vascularity of the limb and flap were restored and computed tomography angiography confirmed patent anastomosis of the Y -shaped vein graft. The Y -shaped vein graft is a novel and simple technique that can be utilized when dealing with calcified vessel anastomosis and can help in restoring the blood supply of the flap and limb together.