Supraclavicular approach for repair of an axillary artery pseudoaneurysm after axillobifemoral bypass

A 61-year-old woman underwent right axillobifemoral bypass using a reinforced expanded polytetrafluoroethylene T-shaped graft for high aortic occlusion. One year later, anastomotic pseudoaneurysm of the axillary artery was noted. We performed pseudoaneurysmectomy and graft interposition at the same anastomotic site through an infraclavicular approach. Unfortunately, the pseudoaneurysm recurred four months later. Therefore, we performed a second reoperation through a supraclavicular approach, in addition to the infraclavicular one. We were able to achieve better exposure from the axillary artery to the distal part of the subclavian artery, and reconstruct the bypass with secure and safe arterial clamping and reanastomosis.