Upper extremity bypass grafting. A 15-year experience.

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.