Carotid-axillary bypass with vertebral artery transposition for superior sulcus tumor resection

Superior sulcus tumors with subclavian artery involvement pose significant challenges to achieving complete resection while preserving cerebral and upper limb perfusion. We report the case of a 47-year-old woman with a left Pancoast tumor undergoing en bloc resection following induction therapy. A carotid-axillary bypass using a ringed polytetrafluoroethylene graft combined with transposition of a dominant vertebral artery to the common carotid artery was performed. The postoperative course was uneventful, with no neurological deficits and preserved limb perfusion. This case highlights that tailored supra-aortic reconstruction can enable safe oncologic resection while maintaining adequate cerebral and upper limb circulation in selected patients.