Superficial Venous Arterialization for Upper Extremity Limb Salvage

Over the past several decades, venous arterialization has attracted renewed research and clinical interest in the treatment of patients with critical limb-threatening ischemia (CLTI) not amenable to endovascular or open revascularization. Upper extremity CLTI attributable to infrabrachial chronic arterial occlusive disease is an infrequently encountered problem in clinical practice for which no evidence-based treatment algorithm exists. Here we describe our approach to a patient with right upper extremity CLTI and limited arterial runoff into the hand. We performed an end-to-side anastomosis between the cephalic vein of the proximal forearm and the distal brachial artery, with complete mechanical valvulotomy of the arterialized vein. The operation yielded a satisfactory technical result, and the patient’s wounds healed completely.