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July 1993

Upper Extremity Bypass Grafting: A 15-Year Experience

Author Affiliations

From the Department of Surgery (Dr Mesh), Case Western Reserve University, Cleveland, Ohio, and the Department of Surgery, Division of Vascular Surgery (Drs McCarthy, Pearce, Flinn, Shireman, and Yao), and the Feinberg Cardiovascular Research Institute (Drs McCarthy, Pearce, Flinn, Shireman, and Yao), Northwestern University Medical School, Chicago, Ill.

Arch Surg. 1993;128(7):795-802. doi:10.1001/archsurg.1993.01420190091012

Objective:  To analyze the perioperative morbidity and mortality, long-term patient survival, and patency characteristics of arterial bypass related to upper extremity ischemia.

Design:  This is a retrospective review of sequential patients undergoing upper extremity arterial bypass during a 15-year period at a single tertiary-care teaching hospital. Data are expressed in a 5-year life-table format and interpreted using log-rank analysis.

Patients:  Seventy-four patients with upper extremity ischemia undergoing arterial bypass, which included 95 separate operations.

Main Outcome Measures:  Operative morbidity and mortality, life-table survival, life-table bypass graft patency, and limb salvage are reported.

Results:  There was no operative mortality, and there was a single major amputation. Survival rate was 86% at 5 years, and overall patency rate was 61.2% at 5 years, with autogenous conduits superior at all sites compared with prosthesis (70.9% vs 37.7%). Secondary operation was inferior to primary bypass (66% vs 48%) and associated with higher morbidity (22% vs 5%). All far distal forearm prosthetic bypass grafts failed within 1 year.

Conclusions:  Primary upper extremity bypass with venous conduit is a safe, durable procedure, after which prolonged patient survival can be expected.(Arch Surg. 1993;128:795-802)

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