Branches of the subclavian artery. The structure of the right and left subclavian arteries. Division into departments

Topography of the subclavian vein:

The subclavian vein starts from the lower border of the 1st rib, goes around it from above, deviates inwards, downwards and slightly forward at the place of attachment to the 1st rib of the anterior scalene muscle and enters the chest cavity. Behind the sternoclavicular joint they connect with the internal jugular vein and form the brachiocephalic vein, which in the mediastinum with the left side of the same name forms the superior vena cava. In front of the subclavian vein is the collarbone. The highest point of the PV is anatomically determined at the level of the middle of the clavicle at its upper border.

Laterally from the middle of the clavicle, the vein is located anterior and inferior to the subclavian artery. Medially behind the vein there are bundles of the anterior scalene muscle, the subclavian artery and, then, the dome of the pleura, which rises above the sternal end of the clavicle. The PV passes anterior to the phrenic nerve. On the left, the thoracic lymphatic duct flows into the brachiocephalic vein.

Subclavian vein puncture technique:

Access to the PV can be either subclavian or supraclavicular. The first is the most common (probably due to its earlier implementation). There are many points for puncture of the subclavian vein, some of them (named by authors) are shown in Fig.

The Abaniak point is widely used, which is located 1 cm below the collarbone along the line dividing the inner and middle third of the clavicle (in the subclavian fossa). Direct the needle for PV puncture at an angle of 45° to the clavicle into the projection of the sternoclavicular joint between the clavicle and 1st rib (along the line connecting the first and second fingers); it should not be punctured deeper.

Wilson's point is located below the clavicle on the midclavicular line. The direction of the PV puncture is between the clavicle and the 1st rib in the projection of the belt notch. The Giles point is determined 2 cm outward from the sternum and 1 cm below the clavicle. The needle path should be behind the collarbone in the projection of the upper edge of the sternoclavicular joint.

With the supraclavicular approach, the Ioffe point is determined in the angle formed by the outer edge of the lateral head of the sternocleidomastoid muscle and the upper edge of the clavicle. The needle is positioned at an angle of 45° to the sagittal plane and 15° to the frontal plane to a depth of usually 1 - 1.5 cm.

Topography of the subclavian artery:

The right subclavian artery arises from the brachiocephalic trunk, the left - directly from the aortic arch. The left subclavian artery is 2-2.5 cm longer than the right one. Throughout P. a. three parts are distinguished: the first - from the place of origin of the artery to the inner edge of the anterior scalene muscle, the second - limited by the limits of the interscalene space, and the third - from the outer edge of the anterior scalene muscle to the middle of the clavicle., where P. a. passes into the axillary a.

The first part of the subclavian artery is located on the dome of the pleura and is covered in front by the anastomosis of the internal jugular vein and on the right by the subclavian vein or the initial part of the brachiocephalic vein and the thoracic duct (on the left). To the anterior surface of the P. a, the vagus nerve and the thoraco-abdominal nerve are adjacent from the inside. Behind the artery is the lower cervical sympathetic node, which, connecting with the first thoracic node, forms the stellate node; medially from P. a. The common carotid artery is located. Right P. a. the loop encircles the recurrent laryngeal nerve, a branch of the vagus nerve. From the first part of P. a. The following branches arise: the vertebral artery, the internal thoracic artery and the thyrocervical trunk.

The second part of the subclavian artery is located directly on the first rib between the anterior and middle scalene muscles. In this part from P. a. The costocervical trunk departs, dividing into the superior intercostal artery and the deep artery of the neck, as well as the transverse artery of the neck. The third part of P. a. located relatively superficially and most accessible for surgical interventions. Anterior to the artery is the subclavian vein. The bundles of the brachial plexus are adjacent to it above, in front and behind.

Surgical tactics for wounds:

In case of damage and bleeding, it is necessary to ligate the subclavian artery or apply a suture to it in one of three zones: above, below and behind the collarbone.

The patient's position is on his back, a cushion is placed under his shoulders, his head is thrown back and turned in the direction opposite to the one on which the operation is being performed. Anesthesia - general or local.

Access to the artery above the clavicle:

When ligating the arteries or placing a vascular suture on it above the collarbone, an incision 8-10 cm long is made 1 cm above the collarbone, which reaches the outer edge of the sternocleidomastoid muscle. The tissues are cut layer by layer. It is necessary to strive to manipulate the rib to avoid injury to the dome of the pleura and the thoracic duct. The exposed artery is isolated, a Deschamps needle is placed under it, ligated and dissected between two ligatures. The central segment must be stitched and tied with two ligatures. The wound is sutured. distal to the thyrocervical trunk, as it is the main collateral of the upper limb.

Access to the artery under the collarbone:

1. When dressing under the collarbone, make an incision up to 8 cm long parallel to the lower edge of the collarbone and 1 cm below. The tissues are dissected layer by layer. They bluntly penetrate the adipose tissue until they find the inner edge of the pectoralis minor muscle, under which the artery is located. Using a Deschamps needle, strong ligatures are placed, tied, and the artery is cut between them.

2. According to Dzhanilidze: arcuate incision. from gr-kl considered 2 cm above to the coracoid process of the scapula, then downwards along the sulcus deltoideopectoralis. cut with a gigli saw. collarbone, push its edges apart. Having found the RCA, perform the necessary manipulation. and connect the edges of the clavicle with a wire suture or knitting needle. According to Petrovsky T-arr access

Subclavian artery,a. subcldvia, starts from the aorta (left) and brachiocephalic trunk (right). The left subclavian artery is approximately 4 cm longer than the right. The subclavian artery leaves the thoracic cavity through its upper aperture, goes around the dome of the pleura, enters (together with the brachial plexus) into the interscalene space, then passes under the clavicle, bends over 1 rib (lies in its groove of the same name) and below the lateral edge of this rib penetrates into axillary cavity, where it continues as the axillary artery.

Conventionally, the subclavian artery is divided into three sections: 1) from the point of origin to the inner edge of the anterior scalene muscle, 2) in the interscalene space and 3) at the exit from the interscalene space. In the first section, three branches depart from the artery: the vertebral and internal thoracic arteries, the thyrocervical trunk, in the second section - the costocervical trunk, and in the third - sometimes the transverse artery of the neck.

1. vertebral artery,a. vertebrdlis, - the most significant of the branches of the subclavian artery, departs from its upper semicircle at the level of the VII cervical vertebra. The vertebral artery has 4 parts: between the anterior scalene muscle and the longus colli muscle there is its prevertebral part, pars prevertebrdlis. Next, the vertebral artery goes to the VI cervical vertebra - this is its transverse process (cervical) part, pars transversdria (cervicalis), then passes upward through the transverse foramina of the VI-II cervical vertebrae. Coming out of the transverse foramen of the II cervical vertebra, the vertebral artery turns laterally and the next section is the atlas part, pars atldntica. Having passed through the hole in the transverse process of the atlas, it bends around from behind its superior articular fossa [surface], pierces the posterior atlanto-occipital membrane, and then the hard shell of the spinal cord (in the spinal canal) and through the foramen magnum enters the cranial cavity - here its intracranial part begins , pars intracranidlis. Posterior to the pons, this artery joins a similar artery on the opposite side to form the basilar artery. From the second, transverse process, part of the vertebral artery depart spinal (radicular) branches,rr. spindles (radiculdres), penetrating through the intervertebral foramina to the spinal cord, and muscle branches,rr. muscles, to the deep muscles of the neck. All other branches are separated from the last - intracranial part: 1) anterior meningeal branch, d.meningeus an terior, And posterior meningeal branch, d.meningeus posterior[meningeal branches,rr. meningei]; 2) posterior spinal artery,a. spindles posterior, goes around the medulla oblongata from the outside, and then descends along the posterior surface of the spinal cord, anastomosing with the artery of the same name on the opposite side; 3) anterior spinal artery,a. spindles anteri or, connects with the artery of the same name on the opposite side into an unpaired vessel that goes down in the depths of the anterior fissure of the spinal cord; 4) posterior inferior cerebellar artery(right and left), a. inferior posterior cerebelli, rounding the medulla oblongata, it branches in the posterior inferior parts of the cerebellum.

basilar artery,a. basildris (see Fig. 47, 48), an unpaired vessel, is located in the basilar groove of the bridge. At the level of the anterior edge of the bridge, it is divided into two terminal branches - the posterior right and left cerebral arteries. From the trunk of the basilar artery depart: 1) anterior inferior cerebellar artery(right and left), a. inferior anterior cerebelli, branch on the inferior surface of the cerebellum; 2) labyrinthine artery(right and left), a. labyrinthi, pass next to the vestibulocochlear nerve (VIII pair of cranial nerves) through the internal auditory canal to the inner ear; 3) arteries of the bridge, aa.pontis (branches to the bridge); 4) middle cerebral arteries, aa.mesencephdlicae (branches to the midbrain); 5) superior cerebellar artery(right and left), a. superior cerebelli, branches in the upper parts of the cerebellum.

posterior cerebral artery,a. cerebri posterior, goes around the cerebral peduncle, branches on the lower surface of the temporal and occipital lobes of the cerebral hemisphere, gives off cortical and central branches. A. flows into the posterior cerebral artery. sopg-municans posterior (from the internal carotid artery), resulting in the formation arterial(Willisian) big brain circle,circulus arteriosus cerebri. The right and left posterior cerebral arteries, which close the arterial circle at the back, participate in its formation. -1 The posterior communicating artery connects the posterior cerebral artery with the internal carotid on each side. The anterior part of the arterial circle of the cerebrum is closed by the anterior communicating artery, located between the right and left anterior cerebral arteries, which arise from the right and left internal carotid arteries, respectively. The arterial circle of the cerebrum is located at its base in the subautinal space. It covers the optic chiasm from the front and sides; The posterior communicating arteries lie on each side of the hypothalamus, the posterior cerebral arteries are in front of the pons.

2. Internal thoracic arterya. thoracica interna (Fig. 49), departs from the lower semicircle of the subclavian artery opposite and slightly lateral to the vertebral artery. The artery descends down the posterior surface of the anterior chest wall, adjacent to the back of the cartilages of the I-VIII ribs. Under the lower edge of the VII rib, it splits into two terminal branches - the muscular-phrenic and superior epigastric arteries. A number of branches depart from the internal mammary artery: 1) mediastinal branchesrr. mediatindles, to the mediastinal pleura and tissue of the upper and anterior mediastinum; 2) thymus branches,rr. thymici; 3) bronchial And tracheal branches,rr. bronchioles et tracheales, to the lower part of the trachea and the main bronchus of the corresponding side; 4) pericardodia-phragmatic artery,a. pericardiacophrenica, starts from the trunk of the artery at the level of the first rib and, together with the phrenic nerve, descends along the lateral surface of the pericardium (between it and the mediastinal pleura), gives branches to it and to the diaphragm, where it anastomoses with other arteries supplying blood to the diaphragm; 5) sternal branches,rr. sterndles, supplying blood to the sternum and anastomosing with the branches of the same name on the opposite side; 6) perforating branches,rr. perfordntes, pass in the upper 5-6 intercostal spaces to the pectoralis major muscle, skin, and the 3rd, 4th and 5th perforating arteries give off [medial] branches of the mammary gland, gg.mammarii [ mediates] (among women); 7) anterior intercostal branches,rr. intercostdles anteriores (I-V), depart in the upper five intercostal spaces in the lateral direction to the intercostal muscles; 8) musculophrenic artery, a.musculophrenica, directed downwards and laterally to the diaphragm. Along the way, it gives off intercostal branches to the muscles of the five lower intercostal spaces; 9) superior epigastric artery, a.epigastrica superior, enters the vagina of the rectus abdominis muscle, through its posterior wall, supplies blood to this muscle, being located on its posterior surface. At the level of the umbilicus, it anastomoses with the inferior epigastric artery (a branch of the external iliac artery). The musculophrenic and superior epigastric arteries are the terminal branches of the internal thoracic artery.

3. Thyrocervical trunk,truncus thyrocervicdlis, arises from the subclavian artery at the medial edge of the anterior scalene muscle. The trunk is about 1.5 cm long and in most cases is divided into 3 branches: the inferior thyroid, suprascapular and transverse cervical arteries. 1) Inferior thyroid artery, a. thyroidea inferior, goes up the anterior surface of the long colli muscle to the thyroid gland and gives off glandular branches,rr. glandular es. They arise from the inferior thyroid artery pharyngeal and esophageal branches,rr. pharyngedles et oesophageals; tracheal branches,rr. tracheales, And inferior laryngeal artery,a. laryngedlis inferior, which, under the plate of the thyroid cartilage, anastomoses with the superior laryngeal artery (a branch of the superior thyroid artery).

2) Suprascapular artery, a. suprascapuldris, behind the clavicle it goes back to the notch of the scapula, through which it penetrates into the supraspinatus and then into the infraspinatus fossa, to the muscles lying there. Anastomoses with the circumflex scapular artery (branch of the subscapular artery) and gives off acromial branch, d.acromidlis, which anastomoses with the branch of the same name from the thoracoacromial artery.

3) Transverse artery of the neck, a. transversa cervicis, most often passes between the trunks of the brachial plexus posteriorly and at the level of the medial end of the spine of the scapula is divided into superficial branch, g.superficidlis, next to the back muscles, and deep branch, Mr.profundus, which runs along the medial edge of the scapula down to the muscles and skin of the back. Both branches of the transverse artery of the neck anastomose with the branches of the occipital artery (from the external carotid artery), the posterior intercostal arteries (from the thoracic aorta), with the subscapular artery and the artery surrounding the scapula (from the axillary artery) (Table 2).

4. costocervical trunk,truncus costocervicdlis, It departs from the subclavian artery in the interscalene space, where it immediately divides into the deep cervical and highest intercostal arteries. 1) Deep cervical artery, a. cervicdlis profunda, follows posteriorly between the 1st rib and the transverse process of the 7th cervical vertebra, to the semispinalis muscles of the head and neck. 2) The highest intercostal artery, a. inter- costdlis suprema, goes down in front of the neck of the first rib and branches in the first two intercostal spaces, giving first And second posterior intercostal artery, aa.intercostdles posterio- res (I- II).

Question:

I beg you to answer this question. I did an ultrasound scan, diagnosis: atherosclerosis of the right subclavian artery (the intima-media complex is thickened to 1.5 mm at the mouth of the right subclavian artery). I'm very worried. Tell me, is this dangerous and what needs to be done to stop this process? I'm really looking forward to your response. Thank you in advance.

Answer:

Thickening of the intima is not a cause for concern. However, it is advisable to check your blood cholesterol levels.

SUBCLAVIA STEAL SYNDROME honey.

Subclavian steal syndrome is a cessation of blood flow through the branches of the proximal subclavian artery, supplying blood to the upper extremities, as a result of which blood enters this section from the arterial circle of the brain, which leads to ischemia of brain tissue; maximum manifestations occur during physical activity.

Etiology

Damage to the vascular wall itself - atherosclerosis (95% of cases), nonspecific arteritis, specific arteritis (in particular, syphilitic)

Pathological tortuosity of arteries, displacement of their mouths, anomalies in the development of the aortic arch

Extra-vasal factors that contribute to compression of the vessel from the outside (accessory cervical ribs, anterior scalene syndrome, etc.).

Clinical picture

Dizziness or lightheadedness (especially during physical exertion), possible blurred vision, hemianopsia and ataxia

Muscle weakness in the limb on the affected side

Absence or weakening of the pulse on the affected side.

Diagnostics

Noninvasive measurement of blood pressure in the upper extremities (the difference for unilateral lesions reaches more than 20 mm Hg)

Differential diagnosis

Subclavian artery occlusion

Occlusion of the subclavian artery is a complete closure of the lumen of the subclavian artery, accompanied by insufficient blood supply to the brain and upper extremities. In vascular surgery and cardiology, stenosis and occlusion of the carotid arteries are more common (54-57%). Occlusion of the first segment of the subclavian artery, according to various authors, is found in 3-20% of cases; Moreover, in 17% of cases there are concomitant lesions of the vertebral artery and/or the second segment of the subclavian artery. Bilateral occlusion of the subclavian artery occurs in 2% of cases; the second and third segments of the subclavian artery are affected much less frequently and do not have independent significance in the pathogenesis of cerebrovascular ischemia. Occlusion of the left subclavian artery occurs 3 times more often than the right one.

The subclavian artery is a paired branch of the aortic arch, consisting of the right and left subclavian arteries that supply blood to the upper limbs and neck. The right subclavian artery originates from the brachiocephalic trunk, the left one directly arises from the aortic arch. Topographically, 3 segments are distinguished in the subclavian artery. From the first segment depart the vertebral artery (supplies the spinal cord, muscles and dura mater of the occipital lobes of the brain), the internal thoracic artery (provides blood supply to the pericardium, main bronchi, trachea, diaphragm, sternum, anterior and superior mediastinum, pectoral muscles, rectus abdominis ) and the thyrocervical trunk (supplies blood to the thyroid gland, esophagus, pharynx and larynx, muscles of the scapula and neck).

The only branch of the second segment of the subclavian artery (costocervical trunk) supplies blood to the muscles of the neck, cervical and the beginning of the thoracic spine. The branch of the third segment (transverse cervical artery) mainly supplies blood to the back muscles.

Causes of occlusion of the subclavian artery

The main reasons causing occlusion of the subclavian artery are obliterating atherosclerosis. obliterating endarteritis. Takayasu's disease (nonspecific aortoarteritis), post-embolic and post-traumatic obliterations.

Atherosclerosis is the most common cause of occlusive lesions of the aorta and its branches. At the same time, atherosclerotic plaques protruding into the lumen of the vessel are formed in the intima of the arteries. As a result of subsequent sclerosis and calcification of the vascular wall in the area of the affected area, deformation and stenosis of the lumen of the vessel gradually progress, which determine the ischemic stage of atherosclerosis. In some cases, atherosclerotic lesions may be complicated by thrombosis, leading to acute ischemia and necrosis of the blood supplying organ (thrombo-necrotic stage of atherosclerosis). Additional risk factors for atherosclerosis include smoking and arterial hypertension. hypercholesterolemia. diabetes. cardiovascular diseases.

Obliterating endarteritis, as the cause of occlusion of the subclavian artery, is characterized by inflammatory changes in the walls of the arteries, pronounced hyperplastic processes leading to thrombosis and obliteration of blood vessels.

Takayasu's disease, named after the Japanese ophthalmologist. who first described it, can occur with damage to the branches of the aortic arch and the development of aortic aneurysms. coarctation syndrome, aortic insufficiency. renovascular hypertension, abdominal ischemia, pulmonary artery damage, general inflammatory reaction. Nonspecific aortoarteritis most often leads to occlusion of the distal (second-third) segments of the subclavian arteries.

The development of occlusion of the subclavian artery can be facilitated by extravasal compression factors: scars and tumors of the mediastinum. curvature of the cervicothoracic spine, cervical osteochondrosis. neck injuries, fracture of the clavicle and first rib with the formation of excess callus, chest injuries. In some cases, occlusion of the subclavian artery is a consequence of congenital anomalies of the aortic arch and its branches.

In the pathogenesis of disorders arising from occlusion of the subclavian artery, the main role is played by ischemia of the tissues supplied by the affected branch. Thus, when the proximal segment of the subclavian artery is occluded, blood enters its distal segment and upper limb through the vertebral artery, which leads to depletion of the blood supply to the brain. This phenomenon, especially manifested during physical activity, is called steel syndrome or “subclavian steal syndrome.”

The rapid development of occlusion of the subclavian artery, associated with associated thrombosis, leads to cerebral ischemia - acute ischemic stroke.

Symptoms of subclavian artery occlusion

Occlusion of the first segment of the subclavian artery is manifested by one of the characteristic syndromes or a combination of them: vertebrobasilar insufficiency. upper limb ischemia, distal digital embolism or coronary-mammary-subclavian steal syndrome.

Vertebrobasilar insufficiency with occlusion of the subclavian artery it develops in approximately 66% of cases. The clinic of vertebrobasilar insufficiency is characterized by dizziness. headaches, cochleovestibular syndrome (hearing loss and vestibular ataxia), visual disturbances due to ischemic optic neuropathy.

Upper limb ischemia with occlusion of the subclavian artery, it is observed in approximately 55% of patients. During ischemia there are 4 stages:

I – stage of full compensation. Accompanied by increased sensitivity to cold, chilliness, a feeling of numbness, paresthesia, and vasomotor reactions. II – stage of partial compensation. Circulatory failure develops against the background of functional load on the upper limbs. It is characterized by transient symptoms of ischemia - weakness, pain, numbness, coldness in the fingers, hand, and forearm muscles. Transient signs of vertebrobasilar insufficiency may occur. III – stage of decompensation. Circulatory insufficiency of the upper extremities occurs at rest. It occurs with constant numbness and coldness of the hands, muscle wasting, decreased muscle strength, and the inability to perform fine movements with the fingers. IV – stage of development of ulcerative-necrotic changes in the upper extremities. Cyanosis, swelling of the phalanges, cracks, and trophic ulcers appear. necrosis and gangrene of the fingers.

Ischemia of stages III and IV with occlusion of the subclavian artery is rarely detected (6-8% of cases), which is associated with the good development of collateral circulation of the upper limb.

Distal digital embolism with occlusion of the subclavian artery of atherosclerotic origin, it occurs in no more than 3-5% of cases. In this case, ischemia of the fingers occurs, accompanied by severe pain, paleness, coldness and impaired sensitivity of the fingers, and occasionally gangrene.

In patients who have previously undergone mammary coronary bypass surgery. in 0.5% of cases it may develop coronary-mammary-subclavian steal syndrome. In this case, hemodynamically significant stenosis or occlusion of the first segment of the subclavian artery can aggravate cardiac ischemia and cause myocardial infarction.

Diagnosis of occlusion of the subclavian artery

Occlusion of the subclavian artery can be suspected already during a physical examination. If the difference in blood pressure in the upper extremities is >20 mm Hg. Art. one should think of a critical stenosis, and >40 mm Hg. Art. – about occlusion of the subclavian artery. The pulsation of the radial artery on the affected side is weakened or absent. With occlusion of the subclavian artery, a systolic murmur is heard in 60% of patients in the supraclavicular region.

Doppler ultrasound or duplex scanning of the vessels of the upper limb helps to detect occlusion of the subclavian artery in 95% of cases. The criteria for occlusion of the first segment of the subclavian artery are vertebral-subclavian steal syndrome, the presence of collateral blood flow in the distal subclavian artery, the presence of retrograde blood flow along the vertebral artery, and a positive reactive hyperemia test.

Peripheral arteriography allows you to finally determine the diagnosis of occlusion of the subclavian artery and treatment tactics. Using X-ray contrast angiography, the level of occlusion of the subclavian artery, retrograde blood flow through the vertebral arteries, the extent of obliteration, the presence of poststenotic aneurysms, etc. are revealed.

Treatment and prognosis of occlusion of the subclavian artery

Occlusion of the subclavian artery, accompanied by subclavian-vertebral steal syndrome, symptoms of vertebrobasilar insufficiency, and ischemia of the upper limb, is an indication for angiosurgical intervention.

Reconstructive interventions for occlusion of the subclavian artery are divided into:

plastic (endarterectomy, resection with prosthetics, implantation of the subclavian artery into the common carotid); shunting (aorto-subclavian bypass, carotid-subclavian bypass, carotid-axillary bypass, cross subclavian-subclavian bypass); endovascular (dilatation and stenting of the subclavian artery, laser or ultrasound recanalization of the subclavian artery).

Due to the high sensitivity of the brain to ischemia and the complexity of the anatomy of the neck, during surgical treatment of occlusion of the subclavian artery, specific complications are possible - intraoperative or postoperative stroke; damage to peripheral nerves with the development of Horner's syndrome, plexitis, paresis of the diaphragm dome, dysphagia; cerebral edema, pneumothorax. lymphorrhea, bleeding.

The prognosis of occlusion of the subclavian artery depends on the nature and extent of damage to the vessel, as well as the timeliness of surgical intervention. Early surgery and good condition of the vessel wall is the key to restoring blood flow in the limb and vertebrobasilar area in 96% of cases.

The subclavian artery (a. subclavia) is a large paired vessel that supplies blood to the occipital parts of the brain, the cerebellum, the cervical part of the spinal cord, the muscles and organs (partially) of the neck, the shoulder girdle and the upper limb.

The right subclavian artery arises from the brachiocephalic trunk (truncus brachiocephalicus), the left - directly from the aortic arch (arcus aortae). The left subclavian artery is 2-2.5 cm longer than the right one. Along the subclavian artery, three parts are distinguished: the first - from the place of origin of the artery to the inner edge of the anterior scalene muscle (m. scalenus ant.), the second - limited by the interscalene space (spatium interscalenum ) and the third - from the outer edge of the anterior scalene muscle to the middle of the clavicle, where the subclavian artery passes into the axillary (a. axillaris).

Rice. 1. Topography of the right subclavian artery: 1 - a. vertebralis; 2 - truncus tliyreocervicalis (removed); 3 - m. scalenus ant. (cut off); 4 - a. subclavia dext.; .5 - m. scalenus post, (deleted); 6 - a. transversa colli (deleted); 7 - truncus costocervicalis.

The first part of the subclavian artery is located on the dome of the pleura and is covered in front by the anastomosis of the internal jugular vein (v. jugularis interna) and on the right by the subclavian vein (v. subclavia) or the initial part of the brachiocephalic vein and the thoracic duct (on the left). The vagus nerve (n. vagus) and the thoraco-abdominal nerve (n. phrenicus) are adjacent to the anterior surface of the subclavian artery from the inside. Behind the artery is the lower cervical sympathetic node, which, connecting with the first thoracic node, forms the stellate node; inward from the subclavian artery is the common carotid artery (a. carotis communis). The right subclavian artery is surrounded by a loop of the recurrent laryngeal nerve (n. laryngeus recurrens) - a branch of the vagus nerve. The following branches depart from the first part of the subclavian artery (Fig. 1): vertebral artery (a. vertebralis), internal thoracic artery (a. thoracica interna) and thyrocervical trunk (truncus thyreocervicalis).

The second part of the subclavian artery is located directly on the first rib between the anterior and middle scalene muscles. In this part, the costocervical trunk (truncus costocervicalis) departs from the subclavian artery, dividing into the superior intercostal artery (a. intercostalis suprema) and the deep artery of the neck (a. cervicalis profunda), as well as the transverse artery of the neck (a. transversa colli).

The third part of the subclavian artery is located relatively superficially and is most accessible for surgical interventions. Anterior to the artery is the subclavian vein (v. subclavia). The bundles of the brachial plexus are adjacent to it above, in front and behind.

Injuries to the subclavian artery in peacetime are relatively rare; gunshot wounds during the Great Patriotic War accounted for 1.8% of all injuries to the blood vessels of the body. When the subclavian artery is injured, simultaneous damage to the vein, stellate ganglion, brachial plexus, pleura and lung, thoracic lymphatic duct is possible. Symptoms of injury to the subclavian artery: circulatory disorders of the upper limb, external bleeding (in 41.7%), pulsating hematoma. When the pleura and lung are simultaneously injured, hemothorax is observed, the thoracic duct is chylothorax, and when the brachial plexus is damaged, complete or partial paralysis of the upper limb is observed. Traumatic aneurysms are relatively rare.

Rice. 2. Incisions for surgery on the subclavian artery: 1 - according to Petrovsky; 2 - according to Lexer; 3 - according to Akhutin; 4 - according to the Reich; 5 - classic; 6 - according to the type of Dobrovolsky section.

Temporary stopping of bleeding from the subclavian artery is carried out by moving the hand behind the back and downwards or by finger pressure, the final stop is by ligating the artery or applying a vascular suture. After ligation of the subclavian artery, gangrene is observed in 20.5% of cases (V.I. Struchkov). Operations on the subclavian artery are performed for aneurysms (see Aneurysm), for some congenital heart defects (tetralogy of Fallot) to create anastomoses between the systemic and pulmonary circulation, for obliterating arteritis, and traumatic arteriovenous fistulas. The main approaches to the subclavian artery - see Fig. 2. Extended access with resection of the clavicle is especially important for traumatic aneurysms. See also Blood vessels.

Each person has two circles of blood circulation - large and small. The large circle carries arterial blood, supplying the body with oxygen, amino acids, glucose and other metabolic products, taking away carbon dioxide.

The small circle has the lungs as its center. Venous blood, saturated with carbon dioxide, gives it to the lungs, absorbs oxygen and goes to the heart. In the heart both circles intersect.

What is the subclavian artery?

This is a large and long vessel of the systemic circulation that supplies blood to the upper parts of the body: the occipital part of the brain, the cerebellum, the cervical spinal cord and spine, the muscles of the shoulder girdle, neck and upper limbs.

What does it consist of?

The organ itself consists of a pair - the subclavian artery and subclavian vein. The subclavian artery arises from the brachiocephalic trunk, a 3-4 cm long remnant of the embryonic aorta, and is located behind the right sternoclavicular joint. It goes around the lung and stretches through the rib into the armpit, passing into the axillary artery. This is exactly how the subclavian artery is located in the human body. Its anatomy is very interesting.

The subclavian vein starts from the aortic arch, runs around the top of the lung and exits over the chest. It is approximately 4-5 cm longer, and if the right part of the vessel is the main supplier of blood to the right side of the body, then the function of the opposite is to supply this blood to the left side.

Branches of the subclavian artery

There are three conventional sections: from the beginning to the end of the interscalene space, the costocervical trunk, and the transverse artery of the neck. The largest branch is the vertebral artery, which arises in the first section at the height of the 7th vertebra and runs between the spinal cord and the brain. The next most important is the steam room.

In the second section there is the internal mammary artery, on which the supply of oxygen to the thyroid gland, bronchi and diaphragm depends.

In the third section, the cervical artery itself passes, which is one fork.

Importance of the subclavian artery

The subclavian artery is very suitable in its position for placing a catheter for administering medications or puncturing the wall for therapeutic or diagnostic purposes. This is due to:

convenient position of the artery - it passes close to the surface of the neck, in the area of the brachial nerve ganglion;
the diameter of the vein lumen is sufficient so that the catheter needle does not touch the walls;
the vessel itself is quite large, so it is not difficult to get into it when punctured;
blood moves faster through the subclavian artery than through the veins of the arms, so the medicine will instantly reach the right atrium and ventricle, then mix with the blood and reach its destination. Access to the subclavian artery is important.

Effect on the body

In normal condition, the subclavian vessels should properly influence the condition of the skin, nails and arm muscles. In this case, the skin should be of normal flesh color, without redness or dark red spots, otherwise this means a violation of capillary circulation, which can lead to the appearance of trophic ulcers.

At the pulsation points on the left and right it should be almost imperceptible. Otherwise, an examination will be needed to rule out an arterial aneurysm or diseases that are accompanied by a rapid heart rate - hypertension, tachycardia, arrhythmia, problems with the thyroid gland. Causes suspicion and disturbance or change in hand movements, their uncoordination.

How to determine the condition of the subclavian artery?

The subclavian and axillary arteries are important to humans. Therefore, at the slightest disturbance in their work, it is necessary to visit a doctor.

Using palpation with two or three fingers, gently pressing, the areas above the collarbones, closer to the neck, and below them, to the beginning of the deltoid muscles, are felt. Some symptoms may require testing:

Excessive pallor of the skin, muscle weakness, deterioration of hair and nails, their fragility and loss. This may mean that parts of the subclavian artery are not working properly. Diseases such as thrombosis, fibromuscular dystrophy, compression of the muscles of the first rib, atherosclerosis and atheromatosis of the aorta are possible - the accumulation of plaques that impede the throughput of the vessel.
Constantly cold hands, loss of skin elasticity, the appearance of lumps, dark red spots or ulcerations on it, weakness when moving the hands, numbness of the hands or fingers, and convulsions indicate obstruction of the artery.
When measured, blood pressure should normally be approximately the same in both arms, and slightly higher in the legs. If the difference between the readings is large, this may also indicate that the artery has narrowed or something is preventing the free flow of blood.

What causes obstruction of the subclavian artery?

Factors influencing the cleanliness of blood vessels and veins are quite banal:

How to avoid problems?

In order for the subclavian artery to be in order, it is necessary to lead as healthy a lifestyle as possible, including eating healthy foods that keep the blood vessels clean, sufficient physical activity, regular preventive examinations, and quitting smoking and alcohol.