Open Surgical Repair of a True Right Axillary Artery Aneurysm With a Reversed Cephalic Vein Bypass

Background Axillary artery aneurysm is a rare vascular pathology, constituting less than 0.5% of all peripheral arterial aneurysms. Their clinical significance lies in the potential for thromboembolic events, progressive enlargement with rupture, or compression of adjacent neurovascular structures. Etiologies include trauma, iatrogenic injury, postobstructive lesions in patients with thoracic outlet syndrome, and chronic degenerative changes, with atherosclerosis being a rare cause. Case Presentation This study presents the case of a 66‐year‐old male, with a history of extensive aortic pathology who presented with right upper extremity paresthesia. Physical examination revealed a palpable, nontender, pulsatile mass in the right axillary fossa, with intact distal pulses bilaterally and no signs of acute ischemia. During preoperative workup for a thoracoabdominal aneurysm, imaging incidentally revealed an aneurysm of the mid‐to‐distal axillary artery measuring 3.0 × 2.8 cm. Given the patient′s neurologic symptoms and thromboembolic risk, open surgical repair was planned. An aneurysmectomy and reversed cephalic vein interposition bypass was performed. Recovery was uneventful, with improvement of the symptoms. At the 6‐month follow up, duplex ultrasound and computed tomography angiography showed patent bypass without hemodynamically significant stenosis. Conclusion This case underscores the importance of patient′s vascular history and symptomatology, meticulous surgical technique, and individualized graft selection in managing axillary artery aneurysms. Vein graft reconstruction provides superior long‐term patency in upper limb aneurysm repair compared to endovascular options, whereas open surgical repair remains the gold standard for symptomatic axillary artery aneurysms.