Proximal

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Abstract
Symptomatic occlusive disease of the proximal portion of the subclavian artery can be managed by several different operative techniques, the most commonly used being the carotid-subclavian bypass. We are submitting a new operative approach: the retroclavicular common carotid axillary bypass technique. For the past two years we have favored this technique over the carotid-axillary artery approach for the following reasons: The proximal part of the axillary artery is far more superficial than the subclavian and can be readily exposed through an infraclavicular pectoralis major musclesplitting incision. Also, the length of axillary artery available for anastomosis is considerably longer and less fragile than the subclavian artery. The subclavian artery exposure is a deep one, limited by the unyielding clavicle and confined to a very small area of exposure. On the left side, the thoracic duct can present problems of lymphorrhea if it is inadvertently lacerated. With the division of a few

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