THE USE OF CAROTID-BRACHIAL BYPASS IN SEVRE ISCHEMIA OF THE UPPER LIMB

Abstract

Introduction. In cases of occlusions in the subclavian-axillary arterial axis with severe upper limb ischemia, the use of endovascular methods or orthotopic bypass may be necessary. When technical limitations or the patient's condition make these options impossible, the carotid-brachial bypass serves as an alternative.

The aim of this study is to assess the feasibility of using extra-anatomic carotid-brachial bypass in revascularizing the upper limb in severe ischemia.

Materials and Methods. The study involves 5 patients with occlusion in the subclavian-axillary axis presenting severe upper limb ischemia. Among them, 3 had acute occlusion due to atherosclerotic stenosis, where initial thrombectomy (embolectomy) procedures failed; one patient had subclavian artery aneurysm thrombosis, and another had grade IV atherosclerotic occlusion with gangrene in the second digit, where endovascular intervention was unsuccessful. All patients underwent a carotid-brachial bypass using an inverted internal saphenous graft. The grafts were placed suprafascially above the clavicle.

Results. Complete resolution of ischemia was observed in all 5 patients. Distal pulses were restored in 4 patients. In the patient with chronic grade IV atherosclerosis and concurrent forearm artery involvement, the pulse was restored at the brachial artery bifurcation. This patient underwent finger amputation. No complications were recorded. Subjective discomfort due to the suprafascial and supraclavicular placement of the bypasses was also not reported.

Conclusion. Suprafascial and supraclavicular carotid-brachial bypasses represent an alternative to orthotopic bypasses, especially in cases where endovascular methods fail or are contraindicated.