SURGICAL EXPOSURE OF THE LEFT SUBCLAVIAN ARTERY BY MEDIAN STERNOTOMY AND LEFT SUPRACLAVICULAR EXTENSION

Objective: To evaluate the feasibility of surgical exposure of the ful l length of the left subclavian artery using a median sternotomy and l eft supraclavicular extension. Design: Anatomic study of five cadavers , and case review of four patients with blunt trauma to the proximal l eft. subclavian artery. Materials and Methods: A median sternotomy wit h left supraclavicular extension was performed on five cadavers and fo ur patients. The depth of various portions of the subclavian artery wa s measured. Photographs of the dissections were used to document anato mic relationships and to serve as a basis for pen and ink drawings. Th e hospital records of four patients in which this exposure was used we re reviewed for operative details. Measurements and Main Results: The left subclavian artery was readily exposed from its origin on the aort ic arch to its termination as the axillary artery in all cadaver disse ctions, first portion of the subclavian artery lag at an average wound depth of 6.0 cm, with a mean length of 4.7 cm, The same surgical appr oach was used for the care of four patients who sustained blunt trauma to the first portion of the left subclavian artery and permitted expe ditious control and excellent exposure for placement of a proximal sub clavian interposition graft in two, a proximal subclavian to axillary artery graft in the third, and resection and end-to-end anastomosis in the fourth, Conclusions: Median sternotomy with left supraclavicular extension provides rapid, safe, and reliable exposure of all portions of the left subclavian artery without the morbidity associated with cl avicular resection, thoracotomy, or a ''trapdoor'' incision. Furthermo re, the ability to perform this procedure in the supine position allow s access to the abdominal cavity, the neck, and the extremities, which often require concomitant operative intervention in a patient with mu ltiple injuries.