Revascularization of the ischaemic hand using in situ veins.

Chronic severe ischaemia of the upper limb is rare, due to the low incidence of arterial disease and to the presence of an adequate pre-existent collateral network. However, sometimes it occasionally occurs, dictating the need for revascularization. Since 1990, the authors have revascularized five upper extremities with severe ischaemic changes, employing the cephalic and/or basilic veins, used in situ. The aetiology of the arterial disease was autoimmune in one case and late sequelae of trauma in the others. Of the in situ venous bypasses performed, three were brachial-radial, and two sequential grafts (one axillary-radial-ulnar and one axillary-brachial-radial-ulnar). One concomitant sympathectomy was performed. All patients had excellent early and late results which leads the authors to recommend such revascularization of the forearm and hand, especially in the presence of severe ischaemia.