Bleeding aneurysm of the axillary artery, managed by a combined approach: interventional radiology and extra-anatomic bypass.

Twenty-two years after an obvious radical mastectomy with axillary lymph node dissection and postoperative conventional radiotherapy for carcinoma of the right breast, an 80-year-old lady was admitted because of the third bleeding episode within one year originating from the axilla. An aneurysm from the axillary artery was identified as the source of hemorrhage. Since the sites of irradiation had to be avoided, an extra-anatomic reversed saphenous vein graft was run from the right common carotid to the brachial artery. In the same session the bleeding was finally controlled by therapeutic embolization of the aneurysm using Gianturco-Anderson-Wallace coils. The postoperative angiogram showed the patent graft. Bleeding did not reoccur during the follow-up period of 17 months.