Below-elbow joint arterial reconstruction for chronic ischaemia

Area of Science:

• Vascular Surgery
• Arterial Reconstruction
• Upper Extremity Ischemia

Background:

• Chronic upper extremity ischemia can significantly impair limb function.
• Common causes include thromboangiitis obliterans, iatrogenic trauma, and unknown etiologies.
• Surgical intervention, such as arterial bypass grafting, is considered for severe cases.

Purpose of the Study:

• To review the outcomes of below-elbow arterial bypass grafts in patients with chronic upper extremity ischemia.
• To evaluate the long-term patency rates and success of these grafts.
• To identify indications and potential challenges of arterial reconstruction in the upper extremity.

Main Methods:

• Retrospective review of ten below-elbow arterial bypass grafts in nine patients.
• Analysis of graft patency, causes of ischemia, and need for revisions.
• Assessment of outcomes based on etiology and surgical approach.

Main Results:

• Eight out of ten grafts (80% primary patency) remained patent from 1 to 10 years (mean 54.3 months).
• No graft failures occurred after 5 months post-operatively.
• Graft revision was necessary in two patients with thromboangiitis obliterans.

Conclusions:

• Autogenous vein bypass grafts to the forearm demonstrate satisfactory long-term patency for chronic upper extremity ischemia.
• Aggressive arterial reconstruction is highly recommended for significant ischemia due to iatrogenic trauma, with excellent success potential.
• The study discusses clinical and technical aspects of in situ vein bypass in the upper extremity.