Carotido-brachial artery bypass for radiation induced injury of the subclavian artery. The value of a lateral mid-arm approach.

Symptomatic subclavian artery damage, following radiation for breast or head and neck cancer, is very rare. We report three new cases in which arterial insufficiency of the upper limb developed respectively 3, 36, and 27 years after irradiation for breast cancer in two cases and tumor of the clavicle in one case. Patients were treated by saphenous vein by-pass using a new extra-anatomic route from the carotid to the brachial artery. They were two main differences from the classical carotido-brachial by-pass. The brachial artery was approached by a lateral mid-arm incision between the biceps and the humeral bone, and the grafts were tunnelled, subcutaneously, laterally on the medial head of the deltoid muscle avoiding the hump of the clavicle, and then between the biceps and the humeral bone. The postoperative courses were uneventful with good healing of the wounds. All grafts remained long-term patent and no compression was detected by ultrasound and arteriogram. This new technique of extra-anatomic carotido-brachial by-pass is a safe and efficient alternative to treat radiation induced injury of the subclavian artery.