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A 15-Year Experience

Charles L. Mesh, MD; Walter J. McCarthy, MD; William H. Pearce, MD; William R. Flinn, MD; Paula K. Shireman, MD; James S. T. Yao, MD, PhD

Arch Surg. 1993;128(7):795-802.

Abstract
Objective
To analyze the perioperative morbidity and mortality, long-term patient survival, and patency characteristics of arterial bypass related to upper extremity ischemia.

Design
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.

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

Main Outcome Measures
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.

(Arch Surg. 1993;128:795-802)

Author Affiliations
From the Department of Surgery (Dr Mesh), Case Western Reserve University, Cleveland, Ohio, and the Department of Surgery, Division of Vascular Surgery (Drs McCarthy, Pearce, Flinn, Shireman, and Yao), and the Feinberg Cardiovascular Research Institute (Drs McCarthy, Pearce, Flinn, Shireman, and Yao), Northwestern University Medical School, Chicago, Ill.

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