Vascular control of the subclavian and axillary arteries

For managing proximal to mid subclavian pathologies, control of the subclavian artery at its origin may be necessary prior to exposing the more distal subclavian or axillary artery. A left anterior thoracotomy incision can be used to control the subclavian artery at its origin. The incision is made medially in the second rib space and carried down along the superior margin of the third rib to enter the chest. The more distal subclavian artery can be controlled using a supraclavicular or infraclavicular incision.
The supraclavicular incision requires sufficient experience to avoid injury to important structures in the vicinity of the artery (eg, phrenic nerve, thoracic duct). If a large hematoma is present, the more lateral infraclavicular incision may be a better choice for initial control. The supraclavicular incision is made one fingerbreadth above the clavicle starting at the lateral edge of the sternocleidomastoid muscle. The proximal axillary artery can be controlled using an infraclavicular incision as it exits the thoracic outlet. Similar to the subclavian artery, if a large hematoma is present in the axilla, a supraclavicular incision to control the subclavian artery proximal to the hematoma may be a better choice over entering the hematoma to control the axillary artery. The infraclavicular incision is made about 1 cm inferior to the clavicle over the lateral aspect of the deltopectoral groove.