title: Carotid brachial bypass for treating proximal upper-extremity arterial occlusive disease.
abstract: Symptomatic occlusive disease of the subclavian arteries, not associated with thoracic outlet syndrome, is an uncommon problem with a paucity of literature related to the appropriateness of bypass graft selection and long-term patency for revascularization. Between 1985 and 1993, 9 patients (3 men and 6 women) underwent 13 carotid brachial bypasses for chronic severe upper-extremity ischemia. Ages ranged from 47 to 75 years (mean 65). Three patients had documented collagen vascular disease, 1 had radiation arteritis, and 4 had bilateral disease requiring staged arterial reconstruction. Indications for operation included severe exercise-induced ischemia in two limbs (15%), rest pain in eight (62%), and gangrene or infection, or both, in three (23%). Two bypasses were performed for failed prior reconstructions. Inflow originated from the carotid artery (4 proximal and 9 bifurcation), and distal anastomoses were made to a disease-free section of brachial artery. Reinforced 6 mm thin-wall polytetrafluoroethylene (PTFE) grafts were used in all operations. No operative mortality or major upper-extremity amputation was associated with the procedure, although digital amputations were performed in four instances. Follow-up ranged from 4 to 83 months with a mean of 38 months. The 5-year primary patency rate, by life-table analysis, was 92%. Our results showed excellent long-term patency when prosthetic grafts were used for carotid brachial bypass, because of excellent runoff and the relatively short graft length required.
authors.affiliation: Department of Surgery, North Eastern Ohio Universities College of Medicine, Youngstown.
authors.forename: A
authors.initials: A
authors.lastname: Gupta
authors.forename: J
authors.initials: J
authors.lastname: Rubin
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D001132:Arm / Q000098:blood supply*; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000601:surgery*; D001366:Axillary Artery / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D001916:Brachial Artery / Q000601:surgery*; D017536:Carotid Artery, Common / Q000601:surgery*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011475:Prosthesis Failure; D013348:Subclavian Artery / Q000601:surgery*; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D011138:Polytetrafluoroethylene