New England Society for Vascular Surgery

Bypass For Chronic Ischemia Of the Upper Extremity: Results In 20 Patients

Kakra Hughes, Allen D Hamdan, Marc Schermerhorn, Anthony Giordano, David R Campbell, Sherry D Scovell, Seth B Blattman, Frank W Logerfo, Frank B Pomposelli, Jr.
Beth Israel Deaconess Medical Center, Boston, MA

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 20, 2003. Simple thromboembolectomy procedures and axillary-axillary/carotid-subclavian bypasses were excluded.
Results:
Twenty patients were identified. Mean age was 57; eleven (55%) were female. Eight (40%) had diabetes and 5 (25%) had renal insufficiency. Indications included tissue loss in 4 patients (29%), rest pain in 5 (36%), and arm/hand numbness in 6 (43%). The etiology of ischemia was atherosclerosis in 7 patients (35%) and iatrogenic or civilian trauma in 13 patients. Conduits used included the great saphenous vein in 11 (55%), arm vein in 7 (35%), and prosthetic in 2 patients (10%). The brachial artery was used as the inflow in 13 patients (65%), the axillary in 6 (30%), and the ulnar in one patient (5%). Outflow targets included the brachial artery in 11 patients (55%), the radial in 5 (25%), and the ulnar in 3 patients (15%). There were no perioperative deaths. There was one (5%) early graft occlusion (within 30 days of surgery). Mean follow-up was 12.4 months. Mean survival after bypass was 62 months. Patency at 1 and 3 years was 90%. Two patients had associated minor amputations (one a finger and another a partial hand amputation). Limb salvage was 100%.
Conclusion:
Although 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 majority being performed for complications of trauma.