Proximal control of subclavian artery

For open control of the proximal subclavian artery at the aortic arch, an anterior thoracotomy is the incision of choice. The incision is made medially on the anterior surface of the left chest in the second rib interspace and carried down along the superior margin of the third rib to avoid injury to the intercostal neurovascular bundle. After entering the left chest, a Finochietto retractor is inserted between the ribs to improve exposure. With a combination of sharp and blunt dissection, the aortic arch and the left subclavian origin can be exposed.