Factors Influencing Patency of Bypass Grafts for Ischemia of the Upper Limb

Abstract

In order to determine factors influencing operative and long-term patency of bypass grafting for upper extremity ischemia, a fifteen-year experience with 39 bypass grafts was reviewed. Etiology of the lesions included atherosclerosis in 17 limbs, thoracic outlet syndrome in 7 cases, violent or iatrogenic trauma in 12 cases, and arteritis in 3. Primary lesions affected the innominate, subclavian, axillary, and brachial artery in 2, 19, 8, and 10 cases respectively. All patients had a complete follow up (mean seventy-one ± forty-four months). The thirty- day, one-year, and five-year patency rates were 92%, 81%, and 78%, respec tively. Indications for operation and type of onset of ischemic symptoms significantly influenced graft patency (p<0.05). Although early results of bypass grafting were better in patients with chronic symptoms (p<0.05), these grafts had a higher incidence of late occlusion (p = NS). Late patency rate was also signifi cantly affected by the site of distal anastomosis, grafts inserted above the elbow achieving the best results (p<0.05). The nature of the graft itself was not a good determinant for bypass patency (p = NS). Finally, better results were obtained in patients with innominate and subclavian artery disease compared with those affected by a more distal arterial lesion (p<0.05).