Optimal proximal anastomosis/tunnel for axillofemoral grafts

The proximal anastomosis of the axillofemoral graft may be optimally placed with standard "cobra-head" technique at an oblique angle to the axillary artery if a subpectoralis minor course of the graft into the anterior-inferior axilla is used. Theoretical advantages of such an anastomosis include improved flow characteristics, decreased tendency to pseudoaneurysm formation, and a decreased tendency to axillary artery thrombosis or brachial artery embolus.