The ascending aorta and aortic arch, up to and including the proximal left subclavian artery, are approached via a median sternotomy.
The descending thoracic aorta distal to the left subclavian artery can be exposed via a left thoracotomy, usually in the second to fourth intercostal space, depending on the location of injury (proximal vs distal).
Distal Subclavian/Axillary
The distal subclavian artery can be exposed via a supraclavicular approach. A transverse incision is made lateral to SCM just superior to the clavicle. This entails identification of the phrenic nerve as well as ligation of lymphatics/thoracic duct.
The axillary artery can be exposed by an infraclavicular transverse incision made in the deltopectoral groove followed by identification and mobilization of the axillary vein, which exposes the axillary artery posterior to it.
Brachial/Forearm
The brachial artery can be exposed by making an incision in the fascia of the biceps muscle and dissecting in the brachial sheath, and mobilizing and preserving the brachial vein and median nerve.
Educational aid only. Verify every dose, indication, and guideline against current institutional protocol. This is not a substitute for clinical judgment.
