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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Rivista di Chirurgia Vascolare ed Endovascolare
Italian Journal of Vascular and Endovascular Surgery 2005 September;12(3):107-11
Distal revascularization for upper limb salvage
Mandolfino T., D’Alfonso M., Canciglia A., Baccellieri D., Spinelli F.
Vascular Surgery Unit University of Messina, Messina, Italy
Aim. The results and long-term patency of distal bypasses for severe upper-limb ischemia are reported.
Methods. Thirteen cases (between 1988 and 2001) of severe upper-limb ischemia with gangrene of one or more fingers were treated. In all cases treatment entailed revascularization with reversed saphenous vein associated with treatment for gangrene and infection.
Results. Two bypasses failed at 1 and 2 months; during follow-up (6-120 months; mean 27 months) a further 2 failed, at 6 and 12 months. Four patients died (at 6 and 54 months, 9 and 10 years); in 2 of these the bypass was occluded. The other patients are still alive with patent bypass.
Conclusion. The severity of ischemia was due to the coexistence of at least one of the factors worsening arterial occlusion, including atheroembolism, radionecrosis and end-stage renal disease. Revascularization with autogenous vein resolved the ischemic event in the presence of severely compromised distal arterial vascularization.