The anterior scalene muscle was divided, and the phrenic nerve was carefully preserved. The left subclavian artery was identified posterior to the anterior scalene muscle.
The left common carotid artery was found by retracting the internal jugular vein medially. The subclavian artery was encircled with the vessel loop in the inferior incision, and the common carotid artery was encircled with the vessel loop in the medial wound.
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The subclavian anastomosis was performed first. Following vascular control, the subclavian artery was opened longitudinally and an 8 mm PTFE ringed graft was sewn in end-to-side fashion with 6-0 polypropylene suture.
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