DISTAL ARTERIAL RECONSTRUCTION USING ESMARCH BANDAGE TECHNIQUE TO SALVAGE UPPER EXTREMITY FUNCTION IN THORACIC-OUTLET-SYNDROME CAUSED BY CERVICAL RIBS - A REPORT OF 2 CASES

We present herein the cases of two patients with thoracic outlet syndr ome (TOS) who required arterial reconstruction due to gangrene of the fingers and/or hand. In both patients, the cervical ribs had produced intimal injury of the subclavian arteries, and the successive distal a rterial embolism brought about severe ischemia of the affected upper e xtremity. To treat the TOS, the cervical ribs were resected through a supraclavicular incision. In the first patient, arterial reconstructio n was performed from the subclavian artery to the radial collateral ar tery, a branch of the deep brachial artery, which resulted in minimizi ng amputation of the gangrenous hand. In the second patient, resection and direct anastomosis of the injured subclavian artery were performe d, and bypass surgery from a brachial artery to an interosseous artery was carried out, preserving finger function. Reversed saphenous vein grafts were utilized and Esmarch's bandage technique was applied as a substitute for a vascular clamp in both patients. Following these case reports, we discuss the technique of performing distal bypass in the upper extremities and comment on the usefulness of Esmarch's bandage t echnique for preserving upper extremity function.