Bypass for chronic ischemia of the upper extremity: Results in 20 patients

• Published in: Journal of vascular surgery 2007-08, Vol.46 (2), p.303-307
• Main Authors: Hughes, Kakra, MD, Hamdan, Allen, MD, Schermerhorn, Marc, MD, Giordano, Anthony, BS, Scovell, Sherry, MD, Pomposelli, Frank, MD
• Format: Article
• Language: English
• Subjects: Aged; Amputation; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis Implantation; Cardiology. Vascular system; Chronic Disease; Databases as Topic; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Emergency and intensive care: renal failure. Dialysis management; Female; Follow-Up Studies; Humans; Intensive care medicine; Ischemia - etiology; Ischemia - mortality; Ischemia - physiopathology; Ischemia - surgery; Kaplan-Meier Estimate; Limb Salvage; Male; Medical sciences; Middle Aged; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Treatment Outcome; Upper Extremity - blood supply; Vascular Patency; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Veins - transplantation
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2007.04.035

Objective Chronic ischemia of the upper extremity requiring surgical revascularization is an uncommon condition. We analyzed modes of presentation, methods of operative repair, and follow-up in all consecutive patients with chronic ischemia of the upper extremity requiring arterial bypass. Methods Data prospectively entered into a vascular registry was retrospectively analyzed for all patients undergoing upper extremity arterial bypass from January 1, 1990, to June 30, 2003. Simple thromboembolectomy procedures and bypasses to an outflow target more proximal than the brachial artery were excluded. Results We identified 20 patients. Their mean age was 57 years, and 11 (55%) were women. Eight (40%) had diabetes, and five (25%) had renal insufficiency. Indications included exercise intolerance in 11 patients (55%), tissue loss in six (30%), and rest pain in three (15%). The etiology of ischemia was atherosclerosis in seven patients (35%) and complications of iatrogenic or civilian trauma in 13 (65%). The brachial artery was used as the inflow in 13 patients (65%), the axillary in six (30%), and the ulnar in one (5%). Conduits used included the great saphenous vein in 11 patients (55%), arm vein in 7 (35%), and prosthetic in 2 (10%). Outflow targets included the brachial artery in 12 patients (55%), the radial in five (25%), and the ulnar in three (15%). There were no perioperative deaths. One graft (5%) occluded ≤30 days of surgery. Mean follow-up was 12 months. Mean survival after bypass was 62 months. Patency at 1 and 3 years was 85%. Two patients had associated minor amputations (a finger and a partial hand). Limb salvage rate was 100%. Conclusion Although upper extremity ischemia is rare, results for upper extremity bypass are excellent and superior to those reported for lower extremity ischemia. These results may reflect the indications, which differ considerably from those for lower extremity bypass, with the most being performed for complications of trauma.