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April 1978

Chronic Upper Extremity Arterial Insufficiency: Etiology, Manifestations, and Operative Management

Author Affiliations

From the Department of Surgery (Drs Gross and Stanley), University of Michigan Medical School, the University Hospital (Drs Gross and Stanley), the US Veterans Administration Hospital (Drs Gross and Stanley), and the St Joseph's Mercy Hospital (Drs Kraft and Flanigan), Ann Arbor, Mich. Read before the 85th annual meeting of the Western Surgical Association, Las Vegas, Nov 15, 1977.

Arch Surg. 1978;113(4):419-423. doi:10.1001/archsurg.1978.01370160077012

• Forty-eight arterial reconstructions were performed for chronic upper extremity ischemia in 43 patients, aged 31 to 81 years. Diagnostic arterial catheterization was the most frequent cause of symptomatic occlusion, followed by proximal arteriosclerotic lesions and noniatrogenic trauma. Doppler ultrasound evaluation provided important diagnostic and prognostic data that complemented information derived from arteriography. Indications for operation included disabling claudication (39 cases) or digital gangrene (four cases). Restoration of normal extremity function can be anticipated except in instances where poor forearm runoff exists. Autogenous saphenous and basilic interposition vein grafts have proved excellent for axillary-brachial revascularizations. Axillary-axillary bypass procedures for innominate-subclavian artery occlusions appear hemodynamically sound and technically simple. Follow-up, averaging 48 months, extended to 144 months. Late vein graft failure or progressive distal occlusive disease was not encountered.

(Arch Surg 113:419-423, 1978)

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