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Staples from a thrombectomy one month prior were removed. Sharp dissection was performed to identify an atretic brachial artery and two old bypasses in this scarred operative field. The cadaveric vein was opened however it was chronically occluded and thus unable to pass a Fogarty. Adjacent to a brachial vein, a small brachial artery was identified. Heparin was given. A transverse arteriotomy was made with an #11 blade. By passing a #2 fogarty, both inflow and outflow was established however no thrombus was noted. This was closed with interrupted 6-0 prolene sutures. Despite a multiphasic doppler signal on this vessel, its size remained diminutive and thus not adequate to perfuse his hand.

On the medial forearm another bypass was noted with mixed echogenicity contents. A separate incision was made. A vein bypass was noted. This too was occluded with subacute to chronic contents and neither Inflow nor outflow was established.