Upper extremity bypass grafting. A 15-year experience
C. L. Mesh, W. J. McCarthy, W. H. Pearce, W. R. Flinn, P. K. Shireman and J. S. Yao
Department of Surgery, Case Western Reserve University, Cleveland, Ohio.
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.
