Left subclavian artery trauma: in situ vs. rib interspace mobilization for primary anastomosis

Fifteen autopsy dissections were performed to evaluate the anatomic relationships of the left subclavian artery and primary arterial anastomosis following trauma. The vessel was transected just beyond the origin of the thyrocervical trunk, and the maximal excisable overlapping segment was determined in situ and through the first and second interspaces. By passing the mobilized left axillary artery through the first intercostal space, up to 7.5 cm of a subclavian arterial segment could be resected and primary arterial repair accomplished. The use of the first interspace to gain additional length in primary repair of the left subclavian artery is suggested as an alternative to grafting.