O perative management of axillosubclavian artery injuries is a challenge because of its location and the vital structures surrounding it. The subclavian artery is located in the transition zone between the thorax, neck, and upper extremity. It is protected by the structures of the thoracic outlet. Vital structures that are in proximity include the subclavian vein, vertebral artery, carotid artery, brachial plexus, aerodigestive tract, and sympathetic nerve chain. Because of this, open operative access to the artery is difficult, time-consuming, and often requires multiple incisions, including but not limited to sternotomy, anterolateral thoracotomy, "trap door" thoracotomy, and supraclavicular and infraclavicular incisions with claviculectomy. For all these reasons, open operative repair is highly morbid. Overall, patients with an isolated axillosubclavian arterial injury that reach the hospital have a mortality rate that ranges from 4.7% to 39%. [1][2][3][4][5] Endovascular repair of the axillosubclavian artery was first described in the 1990s in hemodynamically stable patients. [6][7][8] As surgeons became more facile in endovascular surgery and the technology evolved, the efficiency of this approach improved, and in the 2010s, endovascular repair of axillosubclavian injuries in hemodynamically unstable patients started to be described. 9 The endovascular approach eliminates the need for complex incisions, the risk of injury to surrounding vital structures, and the need to dissect in a bleeding and often distorted surgical field. Thus, the morbidity of the operation is much less given that large complex incisions do not need to be made, there is much lower blood loss, and less operative time is needed. 10 In a small retrospective study comparing endovascular versus open repair of subclavian or axillary artery injuries, endovascular repair was associated with lower in-hospital mortality and surgical site infections, with a trend toward lower rates of sepsis. 11 However, when vessels are injured, and especially transected, it can be challenging to get a wire across the injury. We have developed a step-wise endovascular approach using some previously developed techniques and a novel technique, which together can be used to cross any traumatic lesions, including partial and complete transections. The three techniques that make up this approach are as follows: