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Late upper limb acute ischemia in a patient with an occluded axillo-femoral bypass graft.

A case of severe upper limb ischemia that occurred three months after the occlusion of an axillo-femoral bypass graft (AXB) is described, the third case to be reported in the literature. Although the pathogenesis of this complication is far from clear, the possible role of a short graft in determining traction and finally an angulation of the donor artery is hypothesized. The exact correspondence existing between the length of the AXB and the body size could be altered during the postoperative period by an excessive increase in body weight. The graft could become relatively short for the new conformation and angulation of the axillary artery could be provocated. On the basis of our experience and in reviewing the literature, we believe that an occluded AXB still represents a risk for the donor artery that must be carefully evaluated during accurate follow-up of the patient.