Axillary Artery Injury Attributed to Retractor Placement During Shoulder Arthroplasty: A Case Report on Management and Outcomes

Objective: Axillary artery injury during total shoulder arthroplasty (TSA) is rare but potentially limb-threatening. This report describes an intraoperative arterial injury attributed to retractor placement and highlights its multidisciplinary management and clinical outcome. Methods: A 76-year-old woman with left shoulder pain, restricted range of motion, glenohumeral arthritis, and chondromatous changes underwent TSA. The clinical presentation, intraoperative findings, vascular repair, postoperative management, and 1-year outcome were evaluated. Results: During humeral head resection, significant bleeding in the axillary region became pulsatile after the retractors were removed. Cardiovascular surgeons identified a focal, pinpoint arterial injury considered to be associated with retractor placement. Primary suture repair achieved complete hemostasis without the need for arterial ligation, grafting, or other vascular reconstruction. The planned arthroplasty was subsequently completed during the same surgical session. Postoperative upper-extremity perfusion remained intact. Following rehabilitation, no vascular sequelae were observed, and the patient maintained a satisfactory shoulder range of motion at the 1-year follow-up. Discussion: Early recognition of the injury and immediate involvement of cardiovascular surgery prevented potentially severe hemorrhagic and ischemic complications. This case demonstrates that retractors may endanger the axillary artery during surgical exposure and humeral head resection, even during an otherwise routine TSA. Conclusion: Meticulous retractor placement, detailed knowledge of regional vascular anatomy, and prompt assessment of unexpected bleeding are essential during shoulder arthroplasty. Immediate multidisciplinary intervention and primary vascular repair can preserve limb perfusion and allow safe completion of the planned procedure. Cite this article as: Celayir A, Doğan R, Davulcu CD, Aydın N. Axillary artery injury attributed to retractor placement during shoulder arthroplasty: a case report on management and outcomes. Cerrahpaşa Med J 2026, 50, 0131, doi: 10.5152/cjm.2026.26131.