A 66-year-old female with gait disturbance slipped and fell off her wheelchair at home. She was right-handed and needed a wheelchair in everyday life due to leg weakness of unknown origin. She did not take any medications. She presented to the orthopaedic department of a local hospital complaining of right shoulder pain. Physical examination revealed marked swelling around the right shoulder joint. Additionally, pulsations of the right radial and ulnar arteries were weak but palpable. She also had radial nerve palsy; however, this paralysis gradually ameliorated during physical examination. Right shoulder radiograph showed a proximal humerus fracture with medial displacement of the humeral shaft (), for which closed reduction was attempted under intravenous anaesthesia. Although the humeral shaft displacement was improved after the attempt (), radial and ulnar pulsations were no longer palpable. Therefore, she urgently transferred to our hospital by helicopter. At the time of arrival, her vital signs were stable. Laboratory tests showed the abnormal values in C-reactive protein levels (6.7 mg/L, reference range <1.4 mg/L), creatinine phosphokinase levels (291 IU/L, reference range 41–153 IU/L), and extended activated partial thromboplastin time (41.7 s, reference range 24.0–39.0 s). Haemoglobin (12.3 g/L, reference range 11.6–14.8 g/L), creatinine (0.67 mg/dL, reference range 0.46–0.79 mg/dL), platelets (262 × 109/L, reference range 158–348 × 109/L), prothrombin time (12.8 s, reference range 10.7–12.9 s), and fibrinogen (400 mg/dL, reference range 200–400 mg/dL) were within reference range. Computed tomography (CT) angiography revealed disruption of the right axillary artery () along with contrast medium extravasation and a large haematoma (). Emergency angiography via the right common femoral artery was attempted to confirm the site of injury of the axillary artery after intravenous administration of heparin. However, the prominent meandering of the abdominal aorta and brachiocephalic artery hindered manipulation of the various catheters. Finally, right subclavian angiography was performed using a 4-Fr internal mammary artery catheter, which revealed disruption of the axillary artery distal to the origin of the subscapular artery () and presence of a collateral artery supplying blood to the right brachial artery (, ). In consultation with vascular surgeons, we decided to attempt performing endovascular treatment via the right femoral artery; however, it was impossible due to the pronounced meandering of the abdominal aorta and brachiocephalic artery. Therefore, we attempted to puncture the pulseless right brachial artery under ultrasound guidance, but we were unsuccessful. Fortunately, we were able to cross the breach in the axillary artery using a 0.014-inch guidewire (Cruise®, ASAHI INTECC, Japan) supported by a microcatheter through the 4-Fr internal mammary artery catheter via right femoral artery (, ), and subsequent contrast injection via the microcatheter showed flow in the right brachial artery (). We subsequently successfully punctured the right brachial artery using the guidewire inserted into the right brachial artery across the disrupted axillary artery as a marker (, ). Then, a 6-Fr sheath was inserted into the right brachial artery, and the guidewire which was advanced via right femoral artery was extracted through the 6-Fr sheath in the right brachial artery using a snare catheter (, ). Next, the site of thrombotic occlusion of the axillary artery was observed using an intravascular ultrasound probe (AltaView®, Terumo, Japan) inserted via the brachial artery (), which demonstrated thrombosis and dissection of the axillary artery () and the vessel diameter ranges from 4.5- to 5.0-mm at the occluded lesion and proximal normal axillary artery. We expanded the occluded lesion using a 3.5 mm × 40 mm sized balloon and placed a 5.0 mm × 50 mm Viabahn stent graft (Gore, Flagstaff, AZ, USA) across the lesion via a brachial artery (). Furthermore, the stent graft was dilated with a 5.0 mm × 40 mm sized balloon. The final subclavian injection ensured that distal flow to the brachial artery was preserved and that there was no leakage of contrast medium from the axillary artery (, ). Intravascular ultrasonography images revealed adequate expansion of the stent graft (). After the procedures, the right brachial, radial, and ulnar arteries were well palpable. Computed tomography angiography performed the day after the procedure showed good patency and no dye leakage from the right axillary artery. The patient received dual antiplatelet therapy with aspirin and clopidogrel after the procedure. The shoulder replacement surgery was needed and scheduled, and the patient was then discharged 24 days after the procedure. At 12 months after discharge, the patient had no neurological symptoms, and the radial and ulnar arteries were well palpable. There were no abnormal findings suspecting restenosis or occlusion of the axillary artery.