title: In Situ Venous Bypass for Chronic Hand Ischemia: A Review of 25 Cases in 23 Patients.
abstract: BACKGROUND
  Chronic ischemia of the hand in the setting of atherosclerotic disease is a challenging problem that leads to serial amputations and significant morbidity. Salvage using an in situ venous bypass has been described. In selected cases, leaving the vein in situ for bypass allows a good size match for anastomosis at the wrist or palmar arch. Due to the rarity of the condition, there is a paucity of data regarding the efficacy of this technique.
  
  
  METHODS
  Outcomes in 23 consecutive patients that underwent a total of 25 in situ vein grafts over a 16-year period were retrospectively reviewed.
  
  
  RESULTS
  Eighteen were men and 5 were women with a mean age of 61 years. Target vessels at the wrist or palmar arch were identified on preoperative vascular imaging. The cephalic vein (n = 19, 76%) was most commonly used followed by the basilic vein (n = 6, 24%). Overall patency rate at a mean follow-up period of 12.1 months was 92%. Success as determined by both symptomatic improvement and resolution of the ischemic changes or toleration of revision amputation was achieved in 16 (64%) cases. Postoperative complications occurred in ten cases (40 %). Progression of ischemia occurred in 7 cases (28 %) and 3 (12 %) of these cases required a hand amputation.
  
  
  CONCLUSIONS
  In situ vein grafts in the upper extremity offer good short-term patency rates and can be used for salvage of chronic hand ischemia.
authors.affiliation: From the *Division of Plastic and Reconstructive Surgery, Duke University, Durham, NC; †The Hand Center of San Antonio, San Antonio; and ‡Texas Children's Hospital, Houston, TX.
authors.forename: Agustin
authors.initials: A
authors.lastname: Cornejo
authors.forename: Keith C
authors.initials: KC
authors.lastname: Neaman
authors.forename: Ramesh C
authors.initials: RC
authors.lastname: Srinivasan
authors.forename: Suhail K
authors.initials: SK
authors.lastname: Mithani
authors.forename: William C
authors.initials: WC
authors.lastname: Pederson
mesh_terms: D000328:Adult; D000368:Aged; D050197:Atherosclerosis / Q000150:complications / Q000601:surgery*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006225:Hand / Q000098:blood supply* / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000379:methods*; D014680:Veins / Q000601:surgery*