This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Surgery
Most common site of subclan aery obstruction in subclan steal syndrome is: 
Select and explain. 
A. 1st pa, B. 2nd pa, C. 3rd pa, D. 4th pa
A: 1st pa
Answer: A: 1st pa 
Explanation: The 1st pa of the subclan aery extends from the origin of the subclan aery to the medial border of the scalenus anterior muscle. This pa gives off the veebral aery, the thyrocervical trunk, and the internal thoracic aery. The subclan steal syndrome is characterized by reversal of flow through the veebral aery due to a more proximal (1st pa) occlusion or stenosis of the subclan aery (ie, the veebral aery serves as a collateral to supply blood to the arm). Symptoms of effo fatigue in the involved extremity are more common than neurologic complaints. Treatment consists of bypass grafting from the common carotid to the subclan aery distal to the lesion or transposition of the subclan aery beyond the lesion to the side of the nearby common carotid aery. Ref: Rapp J.H., MacTagga J. (2010). Chapter 34. Aeries. In G.M. Dohey (Ed), CURRENT Diagnosis & Treatment: Surgery, 13e