APPRAISAL OF REVASCULARIZATION OF UPPER EXTREMITY ARTERIAL OCCLUSIVE DISEASE

Document Type : Original Article

Authors

1 Departments of Surgery, El Minia University

2 Departments of Surgery, Cairo University

Abstract

Aim: Symptomatic arterial occlusive disease of the upper extremities requiring revascularization to prevent limb loss is rare. The aim of this work is to review our experience with management of symptomatic, non-traumatic, non-embolic, upper extremity arterial occlusive disease. 
Patients and methods: Forty one patients (44 limbs) were separated into 2 groups. Group 1 (29 patients, 32 limbs) with 
intrinsic arterial occlusive disease and group 2 (12 patients, 12 limbs) with arterial complications secondary to thoracic 
outlet syndrome (TOS). In group 1, seven innominate artery lesions were treated using transthoracic bypass grafts (n = 3) and extra-anatomic bypass grafts (n = 4). All subclavian artery lesions (n = 14) were treated using extra-anatomic bypass. Six of 11 limbs with axillary or brachial occlusions had bypass using saphenous vein, one underwent axillary endarterectomy, 
while 4 were treated conservatively. 
Results: Immediate success rate was 100% with resolution of the ischemic symptoms. Early graft thrombosis in one patient was treated successfully with thrombectomy accounting for early patency rate of 96.4 %. Two more patients developed graft thrombosis at 5 and 12 months resulting in a mid-term patency rate of 92.8%. One patient underwent successful graft thrombectomy the other was treated conservatively and both had good outcome. Arterial complications of TOS in group 2 consisted of subclavian artery stenosis with post-stenotic dilatation and were caused by cervical ribs in 11 patients and fibrous band in one patient. Seven of these 12 patients had embolic occlusion of the brachial artery. All patients underwent excision of the cervical ribs or division of the fibrous band, excision of the diseased subclavian segment with interposition Dacron grafting, and in 7 patients concomitant brachial embolectomy was performed. All patients had resolution of their ischemic symptoms. There was no operative mortality in both groups. 
Conclusion: The results of this study demonstrate that surgical revascularization for upper extremity arterial occlusive 
disease when indicated is safe, well tolerated, and yield a high rate of limb salvage.

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