Upper Extremity Arterial Bypass Distal to the Wrist

Abstract

Since the initial report of Garrett et al.’ in 1965, several surgeons have published their experience with upper extremity revascularization using autogenous With time and experience, these techniques have proven useful for distal bypass procedures at or below the wrist.’ Interposition vein grafting is the reconstructive method of choice following resection of posttraumatic aneurysms of the ulnar artery, a condition first described by von Rosen’ and termed the hypothenar hammer syndrome (HHS) by Conn and associates.” Originally recognized only in machinists, carpenters, and mechanics, the HHS has more recently been described in many occupational and vocational situations, including professional and amateur athletes involved in basketball, badminton, golf, squash, and mountainbiking. 11,12 Patients with the HHS are typically young and productive members of society. Prior to the wide acceptance of interposition vein grafting in the vascular, plastic, and hand surgery literature, ligation was the most commonly recomniended procedure to prevent further embolization and, ulti ma tely, digital amputation. Increased patient survival with end-stage renal disease (ESRD) is creating a larger cohort of patients with severe hand and finger ischemia.’3814 The etiologic backgrounds for these symptoms are diverse and include arterial thrombosis or steal related to dialysis access procedure^,'^-'^ accelerated atherosclerosis, and diffuse arterial calcification and occlu -