Subclavian carotid transposition

To perform subclavian-to-carotid transposition, the subclavian artery is divided proximal to the vertebral artery, and the subclavian artery stump is oversewn. The common carotid artery is exposed, and after obtaining proximal and distal control, an incision is made on its lateral aspect. The subclavian artery is then turned upward, trimmed, and sutured to the common carotid artery. The end-to-side anastomosis is performed using a running 6-0 prolene suture. Cerebral protection is not usually required when operating on an otherwise normal common carotid artery due to the collateral flow from the external carotid to the internal carotid artery.