In Situ Venous Bypass for Chronic Hand Ischemia: A Review of 25 Cases in 23 Patients.

Abstract:

BACKGROUND:Chronic ischemia of the hand in the setting of atherosclerotic disease is a challenging problem that leads to serial amputations and significant morbidity. Salvage using an in situ venous bypass has been described. In selected cases, leaving the vein in situ for bypass allows a good size match for anastomosis at the wrist or palmar arch. Due to the rarity of the condition, there is a paucity of data regarding the efficacy of this technique. METHODS:Outcomes in 23 consecutive patients that underwent a total of 25 in situ vein grafts over a 16-year period were retrospectively reviewed. RESULTS:Eighteen were men and 5 were women with a mean age of 61 years. Target vessels at the wrist or palmar arch were identified on preoperative vascular imaging. The cephalic vein (n = 19, 76%) was most commonly used followed by the basilic vein (n = 6, 24%). Overall patency rate at a mean follow-up period of 12.1 months was 92%. Success as determined by both symptomatic improvement and resolution of the ischemic changes or toleration of revision amputation was achieved in 16 (64%) cases. Postoperative complications occurred in ten cases (40 %). Progression of ischemia occurred in 7 cases (28 %) and 3 (12 %) of these cases required a hand amputation. CONCLUSIONS:In situ vein grafts in the upper extremity offer good short-term patency rates and can be used for salvage of chronic hand ischemia.

journal_name

Ann Plast Surg

authors

Cornejo A,Neaman KC,Srinivasan RC,Mithani SK,Pederson WC

doi

10.1097/SAP.0000000000000761

subject

Has Abstract

pub_date

2016-06-01 00:00:00

pages

S275-9

eissn

0148-7043

issn

1536-3708

pii

00000637-201606004-00004

journal_volume

76 Suppl 4

pub_type

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