A novel technique of upper extremity revascularization: The retrohumeral approach

Abstract

Although the standard approach for inflow to the brachial artery is directly from the subclavian or the carotid artery, unusual scenarios exist when this direct route is not accessible. We present a case of a patient after right radical mastectomy and radiation therapy for breast cancer with severe ischemic symptoms of the dominant right upper extremity. Angiography revealed an occluded right subclavian artery with a paucity of distal collaterals across the right shoulder. A reversed vein graft was constructed from the right common carotid artery to the right brachial artery and was tunneled with a retrohumeral approach to avoid the previously operated and irradiated field. The patient has remained asymptomatic with a patent graft at 2 years. Copyright © 2002 by The Society for Vascular Surgery and The American Association for Vascular Surgery.