Critical arm ischemia—a rare presentation of giant cell arteritis

Giant cell arteritis can rarely present as severe ischemia of the upper limbs. The initial management includes high-dose oral glucocorticoids. However, when patients do not respond to medical therapy, surgical revascularization might be required to reinstitute limb perfusion. We present the case of a 68-year-old woman who had presented with critical arm ischemia that necessitated carotid–brachial artery bypass after initial oral steroid therapy had failed. We have delineated our surgical approach and technical considerations to potentially help increase the long-term patency of the bypass.