{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T01:14:18Z","timestamp":1777943658526,"version":"3.51.4"},"reference-count":15,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2020,2,3]],"date-time":"2020-02-03T00:00:00Z","timestamp":1580688000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Vascular"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Scarring from prior bypass surgery and irradiation may compromise revascularization options in critical ischemia due to underlying occlusive disease. Occlusive disease of the axillo-brachial artery is particularly difficult to revascularize under such hostile conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We present a case of a 58-year-old woman presenting with a painful, pulseless, and cool left upper extremity. The patient had a known history of left upper extremity occlusive disease which was managed by subclavian\u2013axillary artery stenting with re-occlusion and subsequent extra-anatomic left carotid-to-proximal brachial artery prosthetic bypass, which was complicated by stroke. The patient had a history of left mastectomy, axillary node dissection, and external beam radiation therapy. When considering revascularization options, the combination of post-radiation changes and scarring of the conventional operative zones for revascularization posed a high risk for complications. We describe a novel approach for such revascularization, where the inflow source was the terminal brachiocephalic artery, outflow to the upper left brachial artery, with anatomic intrathoracic-to-axillary tunneling through the thoracic outlet after verifying the lack of dynamic extrinsic compression at that level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>The procedure resulted in resolution of the symptoms and the patient continued to do well 2 years later.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case shows that anatomic tunneling through the thoracic outlet can be a viable option for upper extremity revascularization when hostile conditions preclude other anatomic tunneling routes or extra-anatomic options.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1708538119899320","type":"journal-article","created":{"date-parts":[[2020,2,4]],"date-time":"2020-02-04T01:39:33Z","timestamp":1580780373000},"page":"321-324","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Innominate to contralateral brachial artery bypass via ministernotomy with anatomic tunneling for critical ischemia of the left upper extremity"],"prefix":"10.1177","volume":"28","author":[{"given":"Alexandra J","family":"Sharp","sequence":"first","affiliation":[{"name":"Luther College, Decorah, Iowa"},{"name":"Department of Surgery, Carver College of Medicine, Iowa City, Iowa, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1822-9079","authenticated-orcid":false,"given":"Mel J","family":"Sharafuddin","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Iowa Hospitals & Clinics, Iowa City, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2020,2,3]]},"reference":[{"key":"bibr1-1708538119899320","doi-asserted-by":"publisher","DOI":"10.1177\/153857449002400208"},{"key":"bibr2-1708538119899320","first-page":"658","volume":"99","author":"Kretschmer G","year":"1986","journal-title":"Surgery"},{"key":"bibr3-1708538119899320","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800780933"},{"key":"bibr4-1708538119899320","doi-asserted-by":"publisher","DOI":"10.1002\/jso.2930490315"},{"key":"bibr5-1708538119899320","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800600107"},{"key":"bibr6-1708538119899320","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9610(94)80070-7"},{"key":"bibr7-1708538119899320","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800820827"},{"key":"bibr8-1708538119899320","doi-asserted-by":"publisher","DOI":"10.1067\/mva.2002.124626"},{"key":"bibr9-1708538119899320","doi-asserted-by":"publisher","DOI":"10.1016\/0167-8140(90)90101-2"},{"key":"bibr10-1708538119899320","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1177\/096721099300100213","volume":"1","author":"Stein J","year":"1993","journal-title":"Cardiovasc Surg"},{"key":"bibr11-1708538119899320","doi-asserted-by":"publisher","DOI":"10.1016\/0741-5214(86)90143-6"},{"key":"bibr12-1708538119899320","doi-asserted-by":"publisher","DOI":"10.3349\/ymj.2012.53.6.1220"},{"key":"bibr13-1708538119899320","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2017.08.053"},{"key":"bibr14-1708538119899320","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9610(96)00150-X"},{"key":"bibr15-1708538119899320","doi-asserted-by":"publisher","DOI":"10.3988\/jcn.2018.14.1.35"}],"container-title":["Vascular"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1708538119899320","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1708538119899320","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1708538119899320","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T07:32:43Z","timestamp":1777707163000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1708538119899320"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,3]]},"references-count":15,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2020,6]]}},"alternative-id":["10.1177\/1708538119899320"],"URL":"https:\/\/doi.org\/10.1177\/1708538119899320","relation":{},"ISSN":["1708-5381","1708-539X"],"issn-type":[{"value":"1708-5381","type":"print"},{"value":"1708-539X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2,3]]}}}