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Reports of successful treatment of lesions of the innominate artery are rare, particularly those that concern arteriovenous fistula. One of the main problems is the operative approach to the vessels which lie within the thoracic cage and which in the presence of a communication between them increase the difficulties of proper exposure because of the dilatation of the vessels and the increased collateral circulation always attendant on such a lesion. Most textbooks of surgery describe methods of exposure with a view of ligating the innominate artery by resection of the clavicle and disarticulation of its medial end. This has usually been done for aneurysm of the innominate artery in its terminal portion or as a preliminary to operations on the right subclavian and carotid vessels. This exposure is inadequate in the presence of an aneurysm or a fistula near the aorta. The constant danger of hemorrhage makes an adequate exposure
Elkin DC. ARTERIOVENOUS ANEURYSM: THE APPROACH TO THE INNOMINATE VESSELS. JAMA. 1945;129(1):26–27. doi:10.1001/jama.1945.92860350001007
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