[The clavi-pectoral route]. / La voie clavi-pectorale.

ABSTRACT

The clavi-pectoral route provides a limited approach to the axillary vessels as they emerge from the costal-subclavian outlet. The incision is oblique, following the course of the axillary vein. The greater pectoral muscle is split parallel to its fibres, and the smaller pectoral muscle is merely retracted. Only one nerve is exposed the medial pectoral nerve. The vessels are controlled on à length of 4 to 5 cm, enough for catheterization, thrombectomy or central implantation of an axillo-femoral prosthesis. A technical device improves exposure of the artery and ensures haemostasis. The same route can be used for wide anterior resection of the first rib, a necessary stage in venous obstruction clearance, surgery of the outlet syndrome and wide access to the first ganglia of the thoracic sympathetic cord.