American Board of Surgery Qualifying Exam (ABS QE) Practice Test

In addressing distal left subclavian injuries, which approach is typically used?

1. Open thoracotomy

2. Left thoracotomy

3. Median sternotomy

4. Right thoracotomy

The correct answer is: Left thoracotomy

The left thoracotomy is the preferred approach for addressing distal left subclavian injuries due to its ability to provide optimal exposure to the region of interest. This approach allows surgeons direct access to the left thoracic cavity, where the subclavian artery and its branches can be visualized and accessed effectively. Specifically, the left thoracotomy places the surgeon closer to the anatomy of the left subclavian artery and surrounding structures, such as the aortic arch and the left common carotid artery, facilitating both the assessment of any injury and the management of it, including potential repair or reconstruction. This choice is particularly relevant in trauma cases where the injury might be associated with other thoracic injuries. The left thoracotomy approach improves the maneuverability and visibility of the vascular structures, which is critical for managing complex vascular injuries. In comparison, other approaches such as open thoracotomy and median sternotomy are less favorable for this specific injury. Open thoracotomy generally refers to an approach that can be anterior or lateral but is less specific in its access to the left subclavian artery. Meanwhile, median sternotomy provides access to central thoracic structures, which may not offer sufficient exposure to the distal subclavian region. Right thor