A 55-year-old woman was seen in the emergency room (ER), with an ischemic left index and ring finger resulting from a brachial artery occlusion. She underwent brachial artery thrombectomy with basilic vein patch grafting. The patient developed re-thrombosis a few days later and underwent brachial artery bypass using reversed great saphenous vein (GSV) with restoration of arterial flow to the hand. She had a small amount of thrombus (as filling defect) in the radial and ulnar arteries at the wrist with viable hand. There were multiple collaterals around the elbow. Causes of non-embolic brachial artery occlusion are discussed.