Related Experiment Videos
Below-elbow joint arterial reconstruction for chronic ischaemia
T Sakurai1, Y Iwatsuka, N Nishikimi
1First Department of Surgery, Nagoya University School of Medicine, Japan.
Insights
Below-elbow arterial bypass grafts for chronic upper extremity ischemia show satisfactory long-term patency. Arterial reconstruction is effective, particularly for iatrogenic trauma, with excellent success rates.
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.
Abstract:
Ten below-elbow joint arterial bypass grafts performed in nine patients for chronic upper extremity ischaemia are reviewed. The cause of the ischaemia was thromboangiitis obliterans in four patients, iatrogenic trauma in four and unknown aetiology in one. Graft revision was required in two patients with thromboangiitis obliterans who underwent axillary-brachial bypass. Eight grafts, including one reoperation, have remained patent from 1 to 10 years (mean 54.3 months). Graft failure after 5 months did not occur, at which time the primary patency rate was 80%. In general, the long-term patency rates of autogenous vein bypass graft to the forearm were satisfactory. Aggressive arterial reconstruction is especially indicated in significant chronic upper extremity ischaemia resulting from iatrogenic trauma, as chances of success are excellent. Clinical and technical problems of in situ vein bypass in the upper extremity are discussed.