Brachial artery reconstruction for occlusive disease: A 12-year experience

Objective: Symptomatic arterial disease of the upper extremity is an uncomm on problem. In this study, we evaluate our results with brachial artery rec onstruction in patients who present with symptomatic atherosclerotic occlus ive disease and compare this cohort's demographics with a similar group wit h lower extremity ischemia. Methods: From 1986 to 1998, all patients presenting for upper extremity rev ascularization with chronic ischemia were prospectively entered into a vasc ular registry. Demographics, indications, outcomes, and patency were record ed. Patients presenting with embolus, pseudoaneurysm, or trauma were exclud ed. The Fisher exact and Student t tests were used to assess significance. Results: Fifty-one (83%) bypass grafts were performed with autogenous condu it and the remainder with polytetrafluoroethylene. Indications included 18 (30%) patients with exertional arm pain, 35 (57%) with rest pain, and 8 (13 %) with tissue loss. Twenty-five (45%) patients were male, 8 (14%) had diab etes, and 30 (54%) were smokers. The mean age was 58 years (range, 33-93). The operative mortality rate was 1.8%, and follow-up ranged from 1 to 140 m onths. Eight occlusions were identified, with six occurring early. Five of these were in women with a smoking history, Only one of the 26 reconstructi ons that did not cross a joint occluded, whereas bypass grafts that did cro ss a joint occluded more frequently. No other major complications were reco gnized. Conclusion: Arm revascularization for ischemia can be performed with reason able mortality and morbidity rates. These patients may represent a differen t subgroup of atherosclerotic disease than those with lower extremity invol vement: they are more commonly women and smokers and less likely to be diab etic.