Upper extremity complications of axillofemoral grafts

Four patients sustained five upper extremity complications after axillobifemoral grafting including brachial plexus injuries, axillary artery thrombosis, and arterial steal. To avoid these problems, the following precautions are recommended: (1) proper positioning of the patient to prevent hyperabduction of the shoulder; (2) adequate exposure of the axillary artery during dissection and gentle handling of the nerve trunks; (3) meticulous technic during construction of the proximal anastomosis and avoidance of undue tension on the graft; and (4) careful preoperative assessment of the axillary-subclavian artery as a potential donor vessel.