IC Approach – Figure 4
The incision commences 2cm below the clavicle and extends medially to
the sternal border. The two heads of the pectoralis major are identified
and access between the clavicular and manubrial insertions. The
advantages of the IC approach are principally a direct incision over the
first rib in order to access the anteriorly located SV. Removal of this
part of the first rib is crucial in the satisfactory treatment of SV
thrombosis. This enables rigorous debulking of the costchondral junction
and subclavius muscle resection from the origin at the superior aspect
of the medial first rib. The intercostal muscles can be divided from the
lateral rounded aspect of the first rib and medially the dissection can
proceed posteriorly to divide the insertion of the scalenus anterior
muscle. This incision should only be used when the SV needs the be
decompressed as access to the artery and plexus are better served via
the TA or with a separate SC incision. The IC incision can be combined
with a SC approach – the PC. This enables more complete first rib
resection than can be through the other individual approaches.
Furthermore, as the SV is directly exposed, reconstruction can be
performed as well.