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Upper extremity arterial bypass distal to the wrist
M R Nehler1, R L Dalman, E J Harris
1Division of Vascular Surgery, Oregon Health Sciences University, Portland 97201.
Journal of Vascular Surgery
|October 1, 1992
Summary
Arterial bypass surgery distal to the wrist is effective for treating ulnar artery aneurysms and severe hand ischemia in end-stage renal disease patients. Most grafts remained patent, demonstrating the procedure
Area of Science:
- Vascular Surgery
- Microsurgery
- Reconstructive Surgery
Background:
- Ulnar artery aneurysms with digital embolization and hand ischemia in end-stage renal disease (ESRD) patients present significant clinical challenges.
- Distal arterial bypass procedures are crucial for limb salvage in complex vascular conditions affecting the forearm and hand.
Purpose of the Study:
- To evaluate the efficacy and outcomes of arterial bypass procedures performed distal to the wrist.
- To assess the success of these bypasses in patients with traumatic ulnar artery aneurysms and those with ESRD-related hand ischemia.
Main Methods:
- Seventeen distal arterial bypass procedures were performed on 15 patients (13 men, 2 women).
- Procedures included excision and reversed autogenous vein grafting for aneurysms and various bypass configurations (radial-radial, ulnar-ulnar, brachial-radial) for occlusive disease.
- High-quality arteriography, saphenous vein grafts (16/17), and microsurgical techniques were utilized.
Main Results:
- Sixteen out of 17 grafts (94%) remained patent at a mean follow-up of 14 months.
- No operative deaths or major complications occurred.
- The single graft occlusion was associated with only mild cold intolerance.
Conclusions:
- Arterial bypass surgery distal to the wrist is a safe and highly effective treatment for ulnar artery aneurysms and severe hand ischemia in ESRD patients.
- High patency rates and minimal complications support the use of these microsurgical techniques for limb preservation.