Arm ischemia from subclavian artery obstruction is seen infrequently and, when sufficiently symptomatic, can usually be managed by a carotid-subclavian graft. We recently encountered a patient with severe rest pain in his right arm seven years following irradiation of a right Pancoast tumor. The proximal subclavian artery was totally occluded. To avoid operating in an irradiated area, a femoral-axillary graft was performed and has completely relieved the patient's symptoms. A femoral-axillary graft appears to be a reasonable alternative for upper extremity revascularization in patients who are not candidates for more conventional procedures.