Surgical Techniques: Approach to the Axillosubclavian Artery
Exposure of the axillosubclavian artery can be challenging due to the surrounding bony structures, bulky pectoralis muscles, and adjacent nerves. A thorough understanding of the thoracic outlet anatomy facilitates surgical exposure of both the subclavian
- PDF / 674,816 Bytes
- 7 Pages / 504.57 x 720 pts Page_size
- 64 Downloads / 206 Views
85
Michael J. Singh and Dustin J. Fanciullo
Abstract
Exposure of the axillosubclavian artery can be challenging due to the surrounding bony structures, bulky pectoralis muscles, and adjacent nerves. A thorough understanding of the thoracic outlet anatomy facilitates surgical exposure of both the subclavian and axillary arteries. However, given the complex anatomy within a confined surgical field, even to an expert exposure of these vessels is certainly not without risk. This chapter will serve as a review of both the supraclavicular and infraclavicular approaches to the axillosubclavian artery.
Introduction Exposure of the axillosubclavian artery can be challenging due to surrounding bony structures, bulky pectoralis muscles, and adjacent nerves. A thorough understanding of the thoracic outlet anatomy facilitates surgical exposure of both the subclavian and axillary arteries. However, given the complex anatomy within a confined surgical field, even to an expert exposure of these vessels is certainly not without risk. This chapter will serve as a review of both the supraclavicular and infraclavicular approaches to the axillosubclavian artery. M.J. Singh, MD, FACS, RPVI (*) Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Box 652, Rochester, NY 14642, USA e-mail: [email protected] D.J. Fanciullo, MD, RPVI Private Practice, Vascular Surgery, Rochester, NY, USA
An important point should be made regarding planning. Vessels in the groin, legs, arms, and even abdomen are surrounded only by soft tissue, and an experienced and talented vascular surgeon can approach such vessels very quickly if emergencies arise or a traumatic or surgical injury is present. The brachiocephalic vessels, importantly including the subclavian and axillary arteries, do not afford this luxury, and emergent proximal exposure frequently requires time consuming bony resection or division. For this reason we suggest an unusually reasoned, thoughtful planning process prior to exposure of these vessels.
Anatomy The right subclavian artery and right common carotid artery both originate from the innominate artery. The left subclavian artery originates directly off the aortic arch distal to the left common carotid artery. Infrequently, aberrant right
K.A. Illig et al. (eds.), Thoracic Outlet Syndrome, DOI 10.1007/978-1-4471-4366-6_85, © Springer-Verlag London 2013
597
M.J. Singh and D.J. Fanciullo
598 Fig. 85.1 The extrathoracic subclavian artery can be exposed through a supraclavicular incision. Transecting the anterior scalene muscle will expose the vessel. Three major branches originate from the subclavian artery and are: the internal mammary, vertebral and thyrocervical trunk
Phrenic nerve
subclavian artery anatomy is discovered. In these cases, the right subclavian artery originates from the descending thoracic aorta distal to the left subclavian artery. A supraclavicular incision provides excellent exposure of the extra-thoracic subclavian artery. Releasing the anterior scalene muscle provides direct visu
Data Loading...
