Subclavian-carotid transposition: an optimal approach through oblique neck incision

Transposition of the subclavian artery into the common carotid artery has been used commonly to treat proximal subclavian occlusions. The number of transposition operations has recently increased as part of the debranching procedure associated with placement of a thoracic endograft. The major advantage is the avoidance of a prosthetic graft and the excellent long-term results. Traditionally, the operation has been performed through a transverse neck incision. This report describes the technique of transposition through an oblique neck incision made along the anterior border of the left sternocleidomastoid muscles. The surgeon stands on the opposite side of the table. The approach gives exposure of a long segment of the common carotid artery and an excellent view and exposure of the most proximal segment of the subclavian artery. Division of the sternocleidomastoid muscle is avoided.