In situ and composite in situ vein bypass for upper extremity ischaemia

The in situ saphenous vein bypass for lower limb revascularisation is well established. For upper extremity ischaemia necessitating bypass this special technique offers the same advantages. From 1987 to 1991 five patients underwent cephalic and basilic vein in situ bypass for critical ischaemia of the upper extremity. Underlying disease was a thoracic outlet syndrome (two cases), radiation injury (one case) and a chronic atherosclerotic lesion (two cases). One graft failed because of a critical outflow situation. The most important advantage of the in situ technique for revascularisation of the upper extremity seems to be minimal endothelial damage and the better compliance of the in situ vein to the extensive movements of the joints.