Endovascular management of axillofemoral bypass graft stump syndrome.
OBJECTIVE
Upper extremity embolic complications of occluded axillofemoral bypass grafts are infrequent. However, traditional management of dissection of axillary anastomosis for removal of the stump can be challenging. We report two patients with critical upper extremity ischemia secondary to stump syndrome and its successful management with endovascular techniques.


METHODS
One hundred fifty-two patients underwent axillofemoral bypass grafting over 10 years from 1991-2001. Two patients from this series had acute ischemia involving the ipsilateral upper extremity of occluded axillofemoral bypass graft. Duplex ultrasound scans revealed occlusion of the axillofemoral bypass graft and acute occlusion of ipsilateral upper extremity arteries. Both patients underwent brachial artery exploration and embolectomy. Completion angiograms revealed persistent axillofemoral bypass graft stump as the source of embolus. The stump was obliterated with a 10-mm/40-mm Wallgraft introduced through the same arteriotomy made for brachial embolectomy. Transesophageal echocardiography and magnetic resonance angiography of the arch and great vessels were performed to exclude other sources of origin for the embolus.


RESULTS
Both patients remained symptom-free and with patent stent grafts, as seen on duplex scans at 3, 6, and 9 months of follow-up.


CONCLUSIONS
Upper extremity embolism is a rare complication after occlusion of axillofemoral bypass grafts. The endovascular approach to obliterate the stump of occluded axillofemoral bypass grafts is minimally invasive and an effective alternative treatment of this rare condition.
Kallakuri
Sreedhar
S
Division of Vascular Surgery, Department of Surgery, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, USA.
Ascher
Enrico
E
Hingorani
Anil
A
Markewich
Natalia
N
Schutzer
Richard
R
Hou
Alexander
A
Yorkovich
William
W
Jacob
Theresa
T
D000368:Aged; D001132:Arm / Q000098:blood supply*; D001366:Axillary Artery / Q000601:surgery*; D017128:Embolectomy; D004617:Embolism / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D013577:Syndrome