Injuries to the subclavian artery and vein occur infrequently. When these injuries do occur, they are associated with a relatively high mortality primarily due to difficult surgical exposure. A surgeon must have a thorough understanding of the surrounding anatomy and a well-thought-out plan for exposure to give the patient the best chance for survival. In stable patients, computed tomographic angiography can be invaluable for locating the site of injury. Half of patients with subclavian vessel injuries can initially be managed in an endovascular suite but half will require an emergent operation. Access to these vessels depends on the suspected location of injury. There are a series of complications and pitfalls associated with the management of subclavian vessel injury. An understanding of the optimal treatment of patients with these injuries from presentation to postoperative care and how to avoid the common pitfalls is critical for avoiding unnecessary morbidity and mortality. A multidisciplinary effort is necessary for the successful management of these rare vascular injuries.
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