Subclavian Artery
Original Editor - Khloud Shreif
Top Contributors - Khloud Shreif and Lucinda hampton
Introduction
The subclavian artery is a paired artery (right and left subclavian artery) being responsible for the arterial supply to the right and left arms repectively. Additionally some branches from them that give supply to the head and thorax.
Course
The right subclavian artery rise from brachiocephalic artery when it branches to give right common carotid artery and right subclavian artery. The left subclavian artery rise from the aortic arch. The branches ascend superolateral where they terminate to be the axillary artery, before its termination it divides into three parts; the first part medial to anterior scalene, the second part posterior to scalene, and the third part lateral to it where it ends above the first rib to be axillary artery[1].
Branches
As the subclavian artery divide into three parts according to its relation to scalene muscle, each part give a division accoeding to the following (VIT C and D):
- Vertebral artery: the first branch arises from the first part of the subclavian artery before it pass behind the scalene muscle, and course superiorly along each side of the neck.
- Internal thoracic artery, also arises from the first part of the subclavian artery and descend down on the anterior thoracic wall to the umbilics to give supply to all anterior thoracic wall.
- Thyrocervical trunk artery, the third branch that arises from the first part of the subclavian artery, it courses near to the medial border of anterior scalene muscle and give another three branches; inferior thyroid artery, ascending cervical artery, and suprascapular artery.
- Costocervical trunk, arises from the second part posterior to the scalene supplies the first two posterior intercostal spaces, posterior deep cervical muscles
- Dorsal scapular artery, arises from the third part lateral to scalene and supplies levator scapulae , rhomboids, and course around the medial border of scapula
Clinical Relevance
Subclavian steal syndrome, revers the blood flow in the vertebral artery to compensate for subclavian artery stenosis or occlusion[3][1].
Aberrant right subclavian artery (ARSA), a rare normal anatomical variation, where the right subclavian arise from the aorta directly instead of brachiocephalic artery. This variant can be found in about in 0.5% to 1.8% of the population. This artery often pass behind, between, or in front of the esophagus and trachea, which may cause compression and symptoms like difficulty swallowing (dysphagia), breathing issues (dyspnoea), or symptoms similar to vascular rings[4][5].
Subclavian Artery Aneurysm, is a localized dilation of the subclavian artery wall[6][1].
Thoracic Outlet Syndrome (TOS), it can be compressed a the subclavian triangle causing vascular symptoms[1].
Subclavian Artery Dissection, that may happen in response to man causes; arterial catheterization, connective tissue disease or blunt trauma, the symptoms may include pain in the chest, back, or neck, loss of pulse in the arm, dizziness associated with nausea and vomiting, and visual impairments[7].
Intervention
Surgical repair of an aberrant right subclavian artery (ARSA) can be done using; traditional approach using a thoracotomy, TEVAR technique that is minimally invasive technique but is not ideal for young age, or another technique that combines between TEVAR with a carotid-to-subclavian bypass[5].
Surgical removal of extra segment ( seventh rib)it it is comprised and causing vascular symptoms[8].
References
- ↑ 1.0 1.1 1.2 1.3 Robb CL, Bhalla S, Raptis CA. Subclavian artery: Anatomic review and imaging evaluation of abnormalities. RadioGraphics. 2022 Nov;42(7):2149-65.
- ↑ About Medicine. Subclavian Artery - Anatomy, Branches & Relations. Available from: http://www.youtube.com/watch?v=PmFo5ky-Qso [last accessed 30/11/2024]
- ↑ Kikkeri NS, Nagalli S. Subclavian steal syndrome. InStatPearls [Internet] 2023 Jul 3. StatPearls Publishing.
- ↑ Nguyen D, Leon LR, Berman SS. Hybrid repair of aberrant right subclavian artery using open and endovascular techniques. Journal of Vascular Surgery Cases, Innovations and Techniques. 2023 Dec 1;9(4):101307.
- ↑ 5.0 5.1 Heye T, Greiten L, Story-Hefta L, Reemtsen B, Moursi M. Aberrant Right Subclavian Artery, a Novel Approach and an Overview of Operative Techniques. Journal of Vascular Surgery Cases, Innovations and Techniques. 2023 Sep 20:101327.
- ↑ Davidović LB, Marković DM, Pejkić SD, Kovačević NS, Čolić MM, Đorić PM. Subclavian artery aneurysms. Asian journal of surgery. 2003 Jan 1;26(1):7-11.
- ↑ Alloush TK, Alloush AT, Marzouk F, Abdulghani KO, Shokri HM. Post-COVID isolated subclavian artery dissection with multiple cerebral infarctions. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2022 Oct 1;58(1):114.
- ↑ Chang KZ, Likes K, Davis K, Demos J, Freischlag JA. The significance of cervical ribs in thoracic outlet syndrome. Journal of vascular surgery. 2013 Mar 1;57(3):771-5.