Background Severe crush injuries to the upper limb can result in complex arterial damage and acute limb ischaemia, which often precludes primary repair. In such challenging settings, distal-target bypass using an autologous conduit may be required to achieve timely revascularisation and limb salvage. Case presentation A 21-year-old male patient presented with acute ischaemia of the upper limb following a work-related crush injury. Computed tomography angiography revealed a long-segment occlusion of the distal brachial artery and absent distal flow. Emergency surgical exploration revealed extensive arterial and soft-tissue destruction, making primary reconstruction impossible. A long autologous great saphenous vein graft was harvested and tunneled between muscle planes, similar to techniques used in femoropopliteal bypass procedures, to provide a protected, tension-free course. Proximal and distal end-to-side anastomoses were performed between the brachial and radial arteries. Immediate graft patency was confirmed intraoperatively by Doppler ultrasonography and palpable distal pulses. Postoperatively, hand perfusion was restored and limb viability was preserved in the short term, despite associated nerve injury requiring multidisciplinary management. Conclusion Brachial-to-radial artery bypass using a long saphenous vein graft is an effective limb salvage strategy for severe upper extremity crush trauma when primary arterial repair is not possible. Careful graft tunnelling through muscle planes and tension-free anastomoses may contribute to early patency and favourable clinical outcomes.
Fulya Topuz (2026) studied this question.