Approach to the confluence of the subclavian and internal jugular veins without claviculectomy

A new technique is described to approach the confluence of the subclavian vein and the internal jugular, as well as to expose the innominate vein from its origin to the superior vena cava. The operation accomplishes decompression of the subclavian vein and allows direct approach of the subclavian and the innominate veins. It avoids dividing the clavicle or disarticulating the sternal-clavicular joint. It also has the advantage of accomplishing the procedure without entering the pleural cavity. Its reconstruction is explained in detail and achieves solid stability of the sternum and of the shoulder girdle. This approach also prevents deformity that other operations proposed in the past may cause. Copyright (C) 2000 by W.B. Saunders Company.