Upper extremity bypass grafting. A 15-year experience.
OBJECTIVE
To analyze the perioperative morbidity and mortality, long-term patient survival, and patency characteristics of arterial bypass related to upper extremity ischemia.


METHODS
This is a retrospective review of sequential patients undergoing upper extremity arterial bypass during a 15-year period at a single tertiary-care teaching hospital. Data are expressed in a 5-year life-table format and interpreted using log-rank analysis.


METHODS
Seventy-four patients with upper extremity ischemia undergoing arterial bypass, which included 95 separate operations.


METHODS
Operative morbidity and mortality, life-table survival, life-table bypass graft patency, and limb salvage are reported.


RESULTS
There was no operative mortality, and there was a single major amputation. Survival rate was 86% at 5 years, and overall patency rate was 61.2% at 5 years, with autogenous conduits superior at all sites compared with prosthesis (70.9% vs 37.7%). Secondary operation was inferior to primary bypass (66% vs 48%) and associated with higher morbidity (22% vs 5%). All far distal forearm prosthetic bypass grafts failed within 1 year.


CONCLUSIONS
Primary upper extremity bypass with venous conduit is a safe, durable procedure, after which prolonged patient survival can be expected.
Mesh
C L
CL
Department of Surgery, Case Western Reserve University, Cleveland, Ohio.
McCarthy
W J
WJ
Pearce
W H
WH
Flinn
W R
WR
Shireman
P K
PK
Yao
J S
JS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001132:Arm / Q000098:blood supply*; D001158:Arteries / Q000601:surgery; D005260:Female; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D012086:Reoperation; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation*; D015996:Survival Rate; D014654:Vascular Patency