Exposure of the vertebral artery in trauma is challenging. The preferred management approach to injuries of the vertebral artery is angioembolization. However, patients who are hemodynamically unstable or without access to interventional radiology must proceed to the operating room. The vertebral artery can be exposed through one of two approaches: the sternocleidomastoid (SCM) approach, which is the preferred approach in trauma; and the supraclavicular approach, which allows exposure of the first portion of the vertebral artery. This video delineates the relevant anatomy for exposure of the vertebral artery through both approaches and demonstrates the steps in the surgical dissections. Both approaches involve identification of the carotid sheath, which is retracted medially to allow for exposure of the prescalene fat pad. This is dissected free and the underlying anterior scalene muscle and phrenic nerve are identified. The phrenic nerve must be protected, and the anterior scalene muscle is either divided or retracted laterally. This exposes the underlying subclavian artery. The internal mammary artery and the thyrocervical trunk, branches of the subclavian artery, are first identified. Medial dissection reveals the vertebral artery.