Critical arm ischemia-a rare presentation of giant cell arteritis

Giant cell arteritis can rarely present as severe ischemia of the upper limbs. The initial management includes high-dose oral glucocorticoids. However, when patients do not respond to medical therapy, surgical revascularization might be required to reinstitute limb perfusion. We present the case of a 68-year-old woman who had presented with critical arm ischemia that necessitated carotid-brachial artery bypass after initial oral steroid therapy had failed. We have delineated our surgical approach and technical considerations to potentially help increase the long-term patency of the bypass.