Axillary-contralateral brachial artery bypass for radiation-induced occlusion of the subclavian artery

Symptomatic occlusion of the subclavian artery is a rare complication of radiation therapy for carcinoma of the breast. The first case of revascularization of this entity using saphenous vein was described in 1974. A total of only 24 patients have been reported in the English literature, of whom 14 have undergone successful arterial reconstruction. Three additional cases of occlusion of the subclavian artery 27, 18 and 7 years after radical mastectomy and postoperative radiotherapy are reported. These patients presented with pain, coldness, paresthesia and absence of pulses in the affected arm, and angiographic evidence of complete occlusion of the subclavian artery. All patients underwent axillary-contralateral brachial artery reconstruction using a 6-mm polytetrafluoroethylene graft tunneled subcutaneously through the previously irradiated area. In each case, the patient noted complete resolution of symptoms with the return of palpable distal pulses. One patient had a thrombosed graft 5 weeks after initial surgery and underwent successful thrombectomy. There were no complications associated with the subcutaneous tunnel or the production of a subclavian steal syndrome. Although there are other possibilities for the origin of the bypass, this technique avoids extensive dissection in previously irradiated areas and does not require complicated dissection of the subclavian artery or clamping of the carotid artery.