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A series of 136 patients with upper extremity ischemia requiring operative correction is presented. Causes of the ischemia included trauma, atherosclerosis, embolism, iatrogenic causes, radiation injury, and cervical rib syndrome. Operations included primary repair, various bypass grafts and embolectomy. Illustrative case reports are used to emphasize important points. The subclavian, axillary and brachial arteries have been considered separately. In general, ischemia of the arm caused by a discrete lesion is amenable to surgical correction with an excellent change of success.

Following the favorable experience with carotid surgery for occlusive disease, there is increasing surgical interest in extracranial vertebral artery lesions. Such lesions are now frequently encountered in hospital practice. The hospital incidence has increased in recent years, probably due to the ready availability of arteriography in many hospitals and also because of increased awareness of vertebral-basilar insufficiency syndromes. In the joint stroke study [5], the incidence of vertebral lesions was substantial and second only in frequency to carotid lesions. The true incidence may be even higher [6, lo]. Despite the frequency of incidence, vertebral arterial surgery has been slow to evolve because surgical indications are not as well defined [lo] and perhaps because of misapprehension toward small vessel surgery. However, institutions with experience in vertebral arterial surgery are enthusiastic about its clinical benefits [2, 4, 8, 111. The most widely utilized surgical procedure is vertebral artery endarterectomy, sometimes combined with a vein patch angioplasty [2, 31, even though a wide variety of other procedures have been attempted [8, 10, 111. Endarterectomy is an inferior procedure in small vessels due to problems with intimal flap and distal dissection, both of which can easily cause occlusion of a small caliber vessel. It is generally agreed that bypass of occlusive lesions with autogenous blood vessel grafts (arterial grafts are better than venous grafts) is superior to endarterectomy in treating small vessel lesions. The recent

Popliteal artery injury is a common clinical problem which has been associated with a relatively high rate of limb loss. Proper management of popliteal artery injury, which includes attention to minimizing delay, repair of venous injury, careful technique and appropriate fasciotomy can result in substantial improvement in the rate of limb salvage following popliteal artery injury.