Document Detail

A Systematic Review of the Outcomes of Distal Upper Extremity Bypass Surgery With Arterial and Venous Conduits.
MedLine Citation:
PMID:  23044478     Owner:  NLM     Status:  Publisher    
PURPOSE: To conduct a systematic review of literature evaluating efficacy of venous and arterial grafts for distal upper extremity bypass surgery. METHODS: A PubMed search using MeSH terms "veins/surgery" OR "arteries/surgery" AND "radial artery/surgery" OR "ulnar artery/surgery" yielded 794 studies. Manual review produced 42 studies based on inclusion criteria of reported distal upper extremity bypass surgery, complete information on graft type used, examined patency of reconstruction, and described method for determining patency. Studies meeting inclusion criteria underwent data extraction focusing on demographics, revascularization site, conduit type, microsurgical technique, subjective/objective outcomes, and postoperative anticoagulation regimens. RESULTS: Sixteen studies met the inclusion criteria. In 145 patients, 152 grafts were performed for upper extremity revascularization, including 120 grafts for revascularization of distal ulnar artery circulation, 31 for distal radial artery circulation, and 1 for both distal ulnar and radial artery occlusions. Overall patency rate was 87% at an average follow-up of 34 months. Of 152 bypass grafts, 19 were arterial conduits. Donor sites included the deep inferior epigastric artery, subscapular artery, thoracodorsal artery, and descending branch of the lateral femoral circumflex artery. At a mean follow-up of 18 months, arterial conduit patency was 100%. The remaining 133 bypass procedures used vein grafts from various donor sites, including the saphenous, cephalic, and basilic veins. At an average follow-up of 37 months, overall vein graft patency rate was 85%. There was a statistically significant difference between patency rates of arterial conduits compared with venous conduits. All studies reported improved ischemic symptoms including reduction of cold sensitivity, pain, and digital ulceration. CONCLUSIONS: This review showed a high patency rate and clinical efficacy of distal upper extremity bypass surgery with a mean follow-up of almost 3 years. There may be a benefit of using arterial versus venous conduits, although further examination is needed given the small number of arterial reconstructions reported. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
Derek L Masden; Mitchel Seruya; James P Higgins
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-5
Journal Detail:
Title:  The Journal of hand surgery     Volume:  -     ISSN:  1531-6564     ISO Abbreviation:  J Hand Surg Am     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7609631     Medline TA:  J Hand Surg Am     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
The Curtis National Hand Center, Baltimore, Maryland.
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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