title: Long-term follow-up of bypasses to the brachial artery across the shoulder joint.
abstract: BACKGROUND
  Most atherosclerotic lesions in the subclavian artery are successfully treated with carotid to subclavian bypass. The need to bypass to the brachial artery (BA) is rare. We reviewed our experience with this bypass.
  
  
  METHODS
  Over a 10-year period, we have performed 13 bypasses to the BA originating from an artery proximal to the shoulder joint. In this retrospective study, the demographic and clinical risk factors were evaluated. Long-term results were analyzed.
  
  
  RESULTS
  Thirteen operations were performed in 10 patients, aged 47 to 80 years. The operations were carried out for acute severe ischemia in 1 limb, effort discomfort in 9, and rest pain in 3 limbs. Donor arteries were axillary (7), carotid (4), and subclavian (2). All bypasses were to the BA proximal to the elbow joints. Life-table analysis showed 100% patency in the first 3 years and 88% at 7 years. There were 2 deaths in follow-up. Average preoperative brachial to brachial index was 0.59 and postoperative index was 1.1. In patients with bilateral occlusions, mean preoperative brachial artery pressure was 62 mm Hg, which improved to 142 mm Hg postoperatively. There were no neurological complications and no 30-day mortality.
  
  
  CONCLUSIONS
  Bypass across the shoulder joint to the BA using expanded polytetrafluoroethylene (ePTFE) or vein is a safe operation with excellent long-term patency. The carotid artery can be used as a donor vessel without complications. Hypertension and female gender appear to be risk factors for extensive disease in proximal upper extremity arteries.
authors.affiliation: Department of Vascular Surgery, Michigan State University, Kalamazoo Center for Medical Studies, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Jain
authors.forename: E J
authors.initials: EJ
authors.lastname: Simoni
authors.forename: J S
authors.initials: JS
authors.lastname: Munn
authors.forename: D L
authors.initials: DL
authors.lastname: Madson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000098:blood supply*; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000601:surgery*; D001366:Axillary Artery / Q000637:transplantation; D001916:Brachial Artery / Q000601:surgery*; D002339:Carotid Arteries / Q000637:transplantation; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000601:surgery*; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D012189:Retrospective Studies; D012307:Risk Factors; D013348:Subclavian Artery / Q000601:surgery* / Q000637:transplantation; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D011138:Polytetrafluoroethylene