home Audience 12 Subclavian artery and its branches diagram. The structure of the right and left subclavian arteries. Location of the subclavian artery

Subclavian artery and its branches diagram. The structure of the right and left subclavian arteries. Location of the subclavian artery

Takes place in interscalene space, where it lies in the groove of the same name in the first rib. Coming out of the interscalene space, the artery at the outer edge of the first rib continues into the axillary artery, the latter passes into the brachial artery.

The subclavian artery has three sections:

first - from the place of its beginning to the entrance to the interscalene space
second - in the interstitial space
third - from the interscalene space to the entrance to the axillary cavity

There are four segments of the vertebral artery:

prevertebral (V1)- from the subclavian artery to the entrance to the transverse foramen of the VI cervical vertebra
cervical (V2)- in the transverse foramina of the VI-II cervical vertebrae
atlas (V3)- in the transverse foramen and the groove of the same name of the first cervical vertebra
intracranial (V4)- in the cranial cavity

In the neck, they arise from the vertebral artery spinal branches (rr. spinales), which penetrate the spinal canal through the intervertebral foramina. In the cranial cavity the following depart from the vertebral artery:

anterior spinal artery (a. spinalis anterior) - right and left, unite into one trunk, which descends along the anterior median fissure of the medulla oblongata and spinal cord
posterior spinal artery (a. spinalis posterior), steam room, descends along the posterior surface of the medulla oblongata and spinal cord; spinal arteries, running along the spinal cord, anastomose with the spinal branches of the vertebral, intercostal and lumbar arteries.
posterior inferior cerebellar artery (a. cerebelli inferior posterior) - branches on the inferior surface of the cerebellar hemisphere.

Internal thoracic artery

Internal thoracic artery(a. thoracica interna) - originates from the lower surface of the subclavian artery. It supplies the thyroid gland, the connective tissue of the upper and lower anterior mediastinum, the main bronchi, small branches extend to the pericardium, the parietal pleura, the sternum, the diaphragm, the intercostal and pectoral muscles, the rectus abdominis muscle and the skin of this area. It goes in the upper and lower mediastinum. In the upper: behind the sternoclavicular joint. In the lower: behind the cartilages of the first to seventh ribs, 2 cm lateral, and from the lateral edge of the sternum, under the intrathoracic fascia. Below the cartilage of the seventh rib it branches into muscular-diaphragmatic And superior epigastric artery. The latter will anastomose with inferior epigastric artery (a. epigastrica inferior) external iliac artery (a. iliaca externa).

Also departing from it:

pericardiacophrenic artery (a. pericardiacophrenica)
superior epigastric artery- enters the sheath of the rectus abdominis muscle and, as mentioned earlier, anastomoses with inferior epigastric artery (a.epigastrica inferior), which refers to the pool external iliac artery (a. iliaca externa).
musculophrenic artery- goes behind the costal arch and gives off anterior intercostal branches to the fifth intercostal space
perforating branches (rr. perforantes)- women get away from them medial branches of the chest(rr. mammary mediales)
tracheal branches (rr. tracheales)
branches of the thymus (rr. thymici)
bronchial branches (rr. bronchiales)
sternal branches (rr. sternales)
anterior intercostal branches (rr. intercostales anteriores)- two depart in each of the five upper intercostal spaces
mediastinal branches (rr. mediastenalii).

Thyrocervical trunk

Thyrocervical trunk ( truncus thyrocervicalis) - located at the inner edge of the anterior scala layer, rather short.

They depart from it:

inferior thyroid artery ( a. thyroidea inferior), which with its branches supplies blood to the thyroid gland, pharynx, upper esophagus, trachea, larynx
ascending cervical artery ( a. cervicalis ascendens) - rises up the scalene muscles, supplies blood to the deep muscles of the neck and spinal cord
superficial cervical artery ( a. cervicalis superficialis), supplies blood to the skin of the lateral surface of the neck
suprascapular artery ( a. suprascapularis) - goes through scapular notch (incissura scapulae) V supraspinous and infraspinatus fossa (fossa supraspinale et fossa infraspinale), where it supplies blood to the muscles of the same name and anastomoses with the scapular artery of the same name.

Second department

In the second section, only one branch departs from the subclavian artery - costocervical trunk (truncus costocervicalis) . It is also a short structure that almost immediately crumbles into its final branches

Branches of the costocervical trunk:

Deep cervical artery(a. cervicalis profunda) goes back and slightly upward, passes under the neck of the 1st rib, exits into the neck area and follows up to the 2nd cervical vertebra, supplying blood to the deep muscles of the back of the neck, and also sending branches to the spinal cord into the spinal canal. Its branches anastomose with branches from a. vertebralis, a. cervicalis ascendens and from a. occipitalis.
Highest intercostal artery(a. intercostalis suprema) goes down, crosses the anterior surface of the neck of the first rib, and then the second rib and sends to the first and second intercostal spaces posterior intercostal arteries(I and II). (aa. intercostalis posterioris I et II). The latter, following in the intercostal spaces, connect with anterior intercostal branches a. thoracica interna.

From highest intercostal artery depart:

A) spinal branches ( rr. spinalis)

b) posterior branches ( rr. dorsales) to the back muscles.

Third department

In the third section of the subclavian artery, one artery can arise - transverse cervical artery(a.transversum cervicales), but if it is not here, then it will extend directly from the thyrocervical trunk. But we will argue from the most common version of the norm. Transverse artery of the neck o It comes from the subclavian artery at the lateral edge of the scalene muscle. It penetrates the brachial plexus, dividing into the superficial, which supplies blood to the back muscles, and the dorsal scapular artery, which descends along the medial edge of the scapula to the back muscles.

At the girdle of the upper limb, the subclavian artery continues into the axillary artery at the level of the lower edge of the first rib.

Histology of the subclavian artery

The subclavian artery is an artery muscular-elastic type. Its walls are made of three shells:

internal- formed from the endothelium and subedothelial layer. The endothelium is formed by a layer of flat, polygonal, elongated cells with uneven wavy edges that lie on the basement membrane. The subendothelial layer is formed by loose, unformed connective tissue, which contains thin elastic and collagen fibers.
average- consists of smooth muscle cells and elastic fibers, the ratio of which in the tunica media is approximately 1:1. This membrane contains a small number of fibroblasts and collagen fibers.
external- formed by loose fibrous connective tissue containing bundles of smooth myocytes, elastic and collagen fibers. It contains vascular vessels (vasa vasorum), which provide trophic function.

Sources and literature

Atlas of human anatomy Sinelnikova R.D. etc. Volume 3 ISBN 978-5-7864-0201-9
Histology with the basics of histological technology / Edited by V. P. Peshka. Textbook. - Kyiv: CONDOR, 2008. - 400 p. ISBN 978-966-351-128-3
Human anatomy: In 2 volumes - K.: Health, 2005. - T. 2. - 372 p. ISBN 5-311-01342-7


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The human circulatory system is a complex pattern of intricate veins, arteries and many capillaries. The subclavian artery is a paired and very large vessel; it belongs to the arteries of the great circle. It receives blood from the aortic arch and brachiocephalic trunk and supplies the occipital region, part of the spinal cord located in the cervical region, and the cerebellum with nutrients. Also, blood from this vessel supplies oxygen to the upper limbs, shoulder girdle and some parts of the peritoneum and chest.

Anatomy

This artery is a convex arch-shaped vessel located in the anterior mediastinum. Heading up the chest laterally, the vessel bends around the pleura and overlaps the upper part of the lung. The topography of the subclavian artery, relative to the neck area, contributes to the supply of oxygen to the neck muscles and the back of the head.

The vessel is located on the surface and is visible next to the brachial plexus of nerves. The anatomy of the subclavian artery makes it possible to use it to administer medications, and also, in case of heavy bleeding, there is an excellent chance to prevent unpleasant consequences.

Departing from the brachial plexus, the vessel bends over the rib. Here a groove of the subclavian artery is formed, which extends under the collarbone and rises into the armpit. In this area, the vessel passes into the axillary artery. After passing through the armpit, the artery enters the shoulder and becomes the brachial artery. In the area of the elbow joint, the subclavian artery diverges into the ulnar and radial arteries.

Main branches

The left subclavian artery, like the right one, is very large and is part of the systemic circulation. On its way through the body, it gives off several branches through which blood passes to supply oxygen and nutrients to the internal organs, skin, and various parts of the body.

At certain points this vessel diverges into five branches.

Internal thoracic artery

This vessel departs from the main artery in the area of the pleural dome. It passes between the intrathoracic fascia and the pleura, heading towards the lower part of the sternum.

In turn, the thoracic internal artery is divided into:

Vertebral artery

This vessel originates several millimeters medial to the anterior edge of the scalene muscle, in the interscalene space. The anterior part of the artery is covered by the inferior supraclavicular thyroid vessel and the carotid artery.

This branch from the subclavian artery is one of the largest and gives off the following branches:

Posterior inferior cerebellar;
Villous;
Posterior, anterior spinal;
Meningeal.

Thyroid trunk

This vessel has a length of about 0.5-1.5 cm. It branches from the subclavian artery in the area of the anterior scalene muscle.

Just like other branches, it is divided into several arteries branching from it:

Ascending cervical;
Superficial cervical;
Inferior thyroid;
Suprascapular.

Costocervical trunk

This large vessel extends from the wall of the subclavian artery to the small axillary vessel in the interscalene space and is located at the first rib, at its head.

The trunk along its course is divided into the following branches of the great subclavian artery:

Cervical transverse;
Intercostal overhang;
Cervical deep;
Superficial.

Basilar artery

This vessel is formed as a result of the connection of two vertebral arteries in the area of the posterior edge of the bridge.

The following branches of blood channels depart from it:

Departments and functions

The surface location of this vessel is very convenient for puncture. Subclavian artery catheterization is also often performed in this area of the neck. Experts give preference to this area because it is accessible, due to its anatomical features, the artery has a more than suitable lumen diameter and a stable position.

During catheterization, the placed catheter will not come into contact with the walls of the vessel, and the drug that will be administered through it will quickly reach its target, actively influencing hemodynamics.

The main sections of the subclavian artery are three sections:

Interstitial space. The vertebral and paired arteries depart from it;
Costocervical trunk;
Branching of the transverse cervical artery.

The subclavian vessel, located in the 1st section, passes into the skull. Its function is to supply blood to the brain and neck muscles. The internal mammary artery supplies blood to the thyroid gland, diaphragm and bronchi. It is divided into the overhanging intercostal vessel and other adjacent arteries.

Palpation

Palpation and examination of the subclavian artery (palpation) is carried out according to the pattern of palpation of the apical impulse, that is, with three or two fingers. First, the arteries at the edge of the sternocleidomastoid muscles above the collarbones are examined. Then a transition is made to the area of the depth of the subclavian fossae under the collarbones at the edges of its deltoid muscles. The examination is carried out very carefully, using the method of applying fingers and pressing on the soft tissue in the area of the externally examined area.

In a healthy person who is at rest, the subclavian arteries will not be palpated, or their pulsation will be subtle. This is explained by their sufficient depth. You can feel a strong pulsation in people with poor development of the muscle tissue of the shoulder and neck, after physical exertion, emotional shock, as well as in asthenic patients.

With pathology of the subclavian artery, its pulsation is clearly manifested. This phenomenon can be observed with aortic insufficiency and hyperkinetic type of hemodynamics. With a vascular aneurysm, pulsation is usually felt in the supraclavicular area, slightly limited (2-3 cm). The weakening of the pulsation of these arteries can be accurately assessed by palpating them simultaneously using both hands. This may be due to a violation of their patency (thrombosis, compression, atheromatosis) or if there is an anomaly - an aberrant right subclavian artery.

Possible pathologies

The most common disease that affects the subclavian artery and its branches is stenosis. This pathology develops due to the presence of atherosclerosis or thrombosis. The disease can be either congenital or acquired. People who smoke, are overweight and suffer from diabetes are at risk of getting stenosis.

Also, quite often, stenosis develops against the background of impaired metabolism, due to neoplasms and a long-term inflammatory process. During the first course of the disease in acute form, a significant decrease in blood flow is possible, which can cause stroke or ischemia. With stenosis of the subclavian arteries, the majority of patients complain of severe pain, which intensifies with exercise.

Treatment method

A disease such as stenosis can be treated with medication, in its mild form, interventionally and surgically. But the main methods of therapy, according to experts, are bypass surgery and stenting. These treatments have been used for a very long time and have an excellent success rate during the procedure.

Bypass surgery

If stenosis is detected in the 2nd section of the artery, bypass surgery is indicated. If the ipsilateral common carotid artery is damaged, crossover shunting is preferred. This method of surgical intervention does not injure the patient’s tissues and organs, does not require the use of general anesthesia, takes little time and does not cause serious postoperative complications. Before performing it, it is necessary to perform an ultrasound.

If the great subclavian artery is damaged on the left or on both sides, then its reconstruction in the affected area will first be necessary. If the operation is unsuccessful, repeated intervention is difficult. Contralateral lesions of the subclavian vessels require preliminary elimination of the style syndrome, only then can bypass surgery be started. Reconstruction of the damaged section of the artery is possible only with non-regressive vertebrobasilar insufficiency. All surgical interventions, be it bypass surgery, stenting and others, are not carried out without a complete preliminary examination of the patient and an accurate diagnosis.

Stenting

This method is indicated for patients who have a hypersthenic physique and a special topography of their subclavian arteries. The first section of the artery in such people is difficult to feel. The stenting method is very convenient and significantly prevails over surgical abdominal intervention. During this gentle process, no changes occur in the arteries, and body tissues are not injured.

Using stenting, doctors increase the lumen of the affected vessel. For this purpose, a catheter and a balloon-shaped stent are used. All procedures are performed under local anesthesia. The movement of the stent through the artery occurs under the supervision of an experienced specialist who regulates its location. Having reached the narrowing area, the device opens. If the stent is not open enough, angioplasty is performed. The total operation time is no more than 2 hours.

Complications

Although such operations cannot be called complex, they still have a fairly long recovery period. After stenting, it is recommended to take painkillers, since the puncture sites and incisions of the soft tissues and arteries may hurt. Postoperative complications are extremely rare, since before the procedure the patient undergoes a complete examination of the entire body (ultrasound, etc.). But still, the body’s reaction under certain circumstances can be unpredictable (for example, if there is a defect - an aberrant subclavian artery).

After stenting, the patient may experience:

Interventional therapy of stenosis and other diseases of the subclavian arteries using stenting and agioplasty is a modern minimally invasive measure. Such effective procedures are carried out in a very short time and do not require long-term hospitalization. It is enough to first undergo an ultrasound and pass the necessary tests.

The subclavian artery is a paired organ that consists of the right and left arteries. It is part of the systemic circulation and begins in the anterior mediastinum. It is from this artery that the blood supply to the arms, neck and organs located in the upper part of the body depends.

Structure

This artery begins in the anterior mediastinum, the right subclavian artery is the final branch of the brachiocephalic trunk, and the left one begins from the aortic arch. In this case, the left subclavian artery is much longer than the right one, and its intrathoracic part is located behind the brachiocephalic vein. This artery goes around the apex of the lung, as well as the dome of the pleura, forming a convex arch. In the area of the first rib, the brachial plexus is located on it. Having bypassed the rib, the artery goes under the collarbone and passes into the axillary artery.

The left and right subclavian arteries have three main sections. The first section begins at the site of its formation and continues to the interscalene space. The second is located in the interscalene space, and the third section of the artery begins near the exit from the interscalene space and ends at the entrance to the axillary cavity.

Functions

Like any other, this artery delivers blood to the organs. Numerous branches of the subclavian artery depart from its first section. One of them is the vertebral artery, which supplies the spinal cord, dura mater of the brain, and muscles. The internal mammary artery originates from the lower surface of the subclavian artery, which supplies blood to the main bronchi, thyroid gland, sternum, diaphragm, tissue of the anterior and superior mediastinum, as well as the rectus abdominis muscle and chest. The thyrocervical trunk arises from the inner edge of the scalene muscle and divides into branches that supply blood to the larynx, muscles of the scapula and neck.

Only one branch departs from the second section of the artery - the costocervical trunk. It supplies blood to the spinal cord, spinal muscles and other muscles. The transverse artery of the neck departs from the third section, which also supplies blood to the muscles of the shoulder and back.

Diseases

The main disease that can affect the branches of the subclavian artery and the artery itself is stenosis or narrowing of the lumen. The most common cause of stenosis is atherosclerotic changes in blood vessels or thrombosis. Sometimes this disease is congenital, but more often acquired. Among the most common causes of subclavian artery stenosis are metabolic disorders in the body, inflammatory diseases and neoplasms. Severe stenosis, leading to decreased blood flow, causes a deficiency of oxygen and nutrients in the tissues. Stenosis can also cause ischemic stroke. With stenosis, patients most often complain of pain from the affected limb. The pain intensifies with physical activity.

Treatment methods

There are several methods for treating subclavian artery stenosis, the main ones being carotid-subclavian bypass and x-ray endovascular stenting. Carotid-subclavian bypass is usually recommended for patients with a hypersthenic physique in whom it is difficult to isolate the first part of the artery. It is also recommended for stenosis in the second section.

X-ray endovascular stenting - treatment through a small incision in the skin 2-3 mm long through a puncture hole. It has great advantages over surgical intervention, as it causes less trauma to the patient.

Left only subclavian artery, a. subclavia, refers to the number of branches extending directly from the aortic arch, while the right one is a branch of the truncus brachiocephalicus. The artery forms an upwardly convex arc that goes around the dome of the pleura. It leaves the chest cavity through the apertura superior, approaches the collarbone, and lies in the sulcus a. subclaviae of the first rib and bends over it. Here the subclavian artery can be pressed to stop bleeding to the first rib behind the tuberculum m. scaleni. Next, the artery continues into the axillary fossa, where, starting from the outer edge of the first rib, it receives the name a. axillaris.

On its way, the subclavian artery passes together with the brachial nerve plexus through the spatium interscalenum, therefore 3 sections are distinguished in it: the first - from the point of origin to the entrance to the spatium interscalenum, the second - in the spatium interscalenum and the third - at the exit from it, before the transition to a . axillaris.

Branches of the first section of the subclavian artery (before entering the spatium interscalenum):

A. vertebralis, vertebral artery, the first branch extending upward in the interval between m. scalenus anterior and m. longus colli, goes to the foramen processus transversus of the VI cervical vertebra and rises up through the holes in the transverse processes of the cervical vertebrae to the membrana atlantooccipitalis posterior, perforating which, it enters through the foramen magnum of the occipital bone into the cranial cavity. In the cranial cavity, the vertebral arteries of both sides converge towards the midline and, near the posterior edge of the pons, merge into one unpaired basilar artery, a. basilaris. On its way, it gives off small branches to the muscles, spinal cord and dura mater of the occipital lobes of the brain, as well as large branches:

a. spinalis anterior originates in the cranial cavity near the confluence of two vertebral arteries and goes down and to the midline towards the artery of the same name on the opposite side, from which it merges into one trunk;
a. spinalis posterior departs from the vertebral artery immediately after it enters the cranial cavity and also goes down the sides of the spinal cord. As a result, three arterial trunks descend along the spinal cord: an unpaired one - along the anterior surface (a. spinalis anterior) and two paired ones - along the posterolateral surface, one on each side (aa. spinales posteriores). All the way to the lower end of the spinal cord they receive reinforcement through the intervertebral foramina in the form of g. spinales: in the neck area - from aa. vertebrales, in the thoracic region - from aa. intercostales posteriores, in the lumbar - from aa. lumbales. Through these branches, anastomoses of the vertebral artery with the subclavian artery and the descending aorta are established;
A. Cerebelli inferior posterior is the largest of the branches of a. vertebralis, begins near the bridge, goes back and, bypassing the medulla oblongata, branches on the lower surface of the cerebellum.

A. basilaris, basilar artery, obtained from the fusion of both vertebrates, unpaired, lies in the median groove of the bridge, at the anterior edge it is divided into two aa. cerebri posteribres (one on each side), which go back and up, go around the lateral surface of the cerebral peduncles and branch on the lower, inner and outer surfaces of the occipital lobe. Taking into account the aa described above. communicantes posteriores from a. carotis interna, posterior cerebral arteries participate in the formation of the arterial circle of the cerebrum, circulus arteriosus cerebri.

From the trunk a. basilaris small branches extend to the pons, into the inner ear, passing through the meatus acusticus internus, and two branches to the cerebellum: a. cerebelli inferior anterior and a. cerebelli superior. A. vertebralis, running parallel to the trunk of the common carotid artery and participating along with it in the blood supply to the brain, is a collateral vessel for the head and neck. Merged into one trunk, a. basilaris, two vertebral arteries and two aa merged into one trunk. spinales anteriores, form an arterial ring, which, along with the circulus arteriosus cerebri, is important for the collateral circulation of the medulla oblongata.

Truncus thyrocervicalis, thyrocervical trunk, departs from a. subclavia upward at the medial edge of m. scalenus anterior, has a length of about 4 cm and is divided into the following branches:

a. thyroidea inferior goes to the posterior surface of the thyroid gland, gives off a. laryngea inferior, which branches in the muscles and mucous membrane of the larynx and anastomoses with a. laryngea superior; branches to the trachea, esophagus and thyroid gland; the latter anastomose with the branches of a. thyroidea superior from the system a. carotis externa;
a. cervicalis ascendens ascends upward along m. scalenus anterior and supplies the deep muscles of the neck; c) a. suprascapularis goes from the trunk downwards and laterally, to the incusura scapulae, and, bending over the lig. transversum scapulae, branches in the dorsal muscles of the scapula; anastomoses with a. circumflexa scapulae.

A. thoracica interna, internal thoracic artery, departs from a. subclavia against the beginning of a. vertebralis, directed downwards and medially, adjacent to the pleura; starting from the first costal cartilage, it runs vertically downwards at a distance of about 12 mm from the edge of the sternum. Having reached the lower edge of the VII costal cartilage, a. thoracica interna is divided into two terminal branches: a. musculophrenica stretches laterally along the line of attachment of the diaphragm, giving branches to it and in the nearest intercostal spaces, and a. epigastrica superior - continues the path of a. thoracica interna downwards, penetrates the vagina of the rectus abdominis muscle and, reaching the level of the navel, anastomoses with a. epigastica inferior (from a. iliaca externa). On its way a. thoracica interna gives branches to the nearest anatomical structures: the connective tissue of the anterior mediastinum, the thymus gland, the lower end of the trachea and bronchi, the six upper intercostal spaces and the mammary gland. Its long branch, a. pericardiacophrenica, together with n. phrenicus goes to the diaphragm, giving branches to the pleura and pericardium along the way. Its rami intercostales anteribres go in the upper six intercostal spaces and anastomose with aa. intercostales posteriores (from the aorta). Branches of the second section of the subclavian artery:

Truncus costocervicalis, costocervical trunk, departs into the spatium interscalenum, goes back and up to the neck of the first rib, where it divides into two branches that penetrate the posterior muscles of the neck and give branches in the canalis vertebralis to the spinal cord and into the first and second intercostal spaces. Branches of the third section of the subclavian artery:

A. transversa colli, transverse artery of the neck, pierces the plexus brachialis, supplies neighboring muscles and descends along the medial edge of the scapula to its lower angle.

The subclavian artery (a. subclavia) is a large paired vessel, part of the subclavian neurovascular bundle of the neck, which is formed by the subclavian artery, subclavian vein and brachial plexus.

The right subclavian artery arises from the brachiocephalic trunk (truncus brachiocephalicus), the left one - directly from the aortic arch (arcus aortae), therefore the left one is 4 cm longer than the right one. Along the course of the subclavian artery and according to its relationship with the anterior scalene muscle, three sections are distinguished.

On its way, the subclavian artery passes together with the brachial nerve plexus through the spatium interscalenum, formed by the adjacent surfaces of the anterior and middle scalene muscles, and passes along the first rib in the sulcus a. subclaviae. Therefore, in the subclavian artery, 3 sections are topographically distinguished: the first section - from the place of origin of the artery to the inner edge of the anterior scalene muscle (m. scalenus ant.) in the scalenovertebral space (spatium scalenovertebrale), the second - limited by the limits of 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). In the third section, the subclavian artery can be pressed to stop bleeding to the first rib behind the tuberculum m. scaleni.

The 1st section of the subclavian artery gives off three important branches:

vertebral (a. vertebralis), thyroid trunk (truncus thyrocervicalis), internal thoracic artery (a. thoracica interna). As well as branches from the thyroid cervical trunk (truncus thyreocervicalis): the inferior thyroid artery (a. thyroidea inferior), and its branch - the ascending cervical artery (a. cervicalis ascendens), the superficial cervical artery (a. cervicalis superficialis), the suprascapular artery (a. suprascapularis). The suprascapular artery (a. suprascapularis) participates in the formation of the scapular arterial circle.

The 2nd section of the subclavian artery gives branches: the costocervical trunk (truncus costocervicalis) and its branches: the uppermost intercostal artery (a. intercostalis suprema), and the deep cervical artery (a. cervicalis profunda), penetrating into the muscles of the posterior neck.

The third section of the subclavian artery is located in the outer triangle of the neck, here the transverse artery of the neck (a. transversa colli) departs from the artery, which pierces the plexus brachialis, supplies neighboring muscles and descends along the medial edge of the scapula to its lower angle. All elements of the subclavian vascular-nerve bundle are connected together to pass into the axillary fossa of the upper limb.

Brachial plexus.

The brachial plexus, plexus brachialis, is composed of the anterior branches of the four lower cervical nerves and most of the first thoracic nerve; often a thin branch from C111 is added. The brachial plexus exits through the space between the anterior and middle scalene muscles into the supraclavicular fossa, located above and behind a. subclavia. From it arise three thick nerve bundles that go into the axillary fossa and surround a. axillaris on three sides: lateral (lateral fascicle), medial (medial fascicle) and posterior to the artery (posterior fascicle). The plexus is usually divided into supraclavicular (pars supraclavicularis) and subclavicular (pars infraclavicularis) parts. Peripheral branches are divided into short and long. Short branches depart from various places of the plexus in its supraclavicular part and partly supply the muscles of the neck, as well as the muscles of the upper limb girdle (with the exception of the m. trapezius) and the shoulder joint. Long branches arise from the above three bundles and run along the upper limb, innervating its muscles and skin. Projection of the brachial plexus: the patient’s head is turned in the direction opposite to the surgeon’s and tilted upward. The projection corresponds to the line connecting the border between the middle and lower thirds of the posterior edge of the sternocleidomastoid muscle with the middle of the upper edge of the clavicle.

Ticket 78

1. Topography of the outer triangle of the neck: boundaries, external landmarks, layers, fascia and cellular spaces, vessels and nerves. 2. Scapular-clavicular triangle. 3. Vascular-nerve bundle of the outer triangle. 4. Scapular-trapezoidal triangle. 5. Vascular-nervous formations. 6. Projection onto the skin of the subclavian artery, surgical access to the artery according to Petrovsky.

1. Topography of the outer triangle of the neck: boundaries, external landmarks, layers, fascia and cellular spaces, vessels and nerves.

Borders: in front by the lateral (posterior) edge of m. sternocleidomastoideus, behind - by the anterior edge of the trapezius muscle (musculus trapezius), below - by the clavicle (clavicula).

The lower belly of the scapular-hyoid muscle (m. omohyoideus) divides the lateral region into two triangles: the larger scapular-trapezoid triangle (trigonum omotrapezoideum) and the smaller scapular-clavicular triangle (trigonum omoclaviculare).

External landmarks that form the boundaries of an area. An important landmark is the posterior edge of the sternocleidomastoid muscle, m. sternocleidornastoideus, clearly visible, especially when turning the head in the opposite direction, as well as the anterior edge of the trapezius muscle - the posterior one. The collarbone limits the area below.

2. Scapular-clavicular triangle (trigonum omoclaviculare).

Borders: in the triangle, the lower border is the clavicle, the anterior border is the posterior edge of the sternocleidomastoid muscle, the superoposterior border is the projection line of the lower belly of the omohyoid muscle (m. omohyoideus).

External landmarks: greater supraclavicular fossa, fossa supraclavicularis major.

Layers and fascia: Skin, subcutaneous fat, fascia. The skin of the scapuloclavicular triangle is thin and mobile. The superficial fascia and platysma of the scapuloclavicular triangle cover the entire triangle, as does the superficial plate of the cervical fascia (2nd fascia). Between the 1st and 2nd fascia in the lower part of the scapuloclavicular triangle, along the posterior edge of the sternocleidomastoid muscle, runs v. jugularis externa. It pierces the 2nd and 3rd fascia and flows into the angle of the confluence of the subclavian and internal jugular veins or through a common trunk with the internal jugular vein into the subclavian vein. The adventitia of the vein is connected to the fascia that it perforates, so when wounded it gapes. In this case, along with heavy bleeding, an air embolism is also possible. The pretracheal plate of the fascia of the neck (3rd fascia) is located below the m. omohyoideus, behind the 2nd fascia of the neck. Together with it, it is attached to the collarbone. Behind the 3rd fascia in the scapuloclavicular triangle there is an abundant layer of fatty tissue containing the supraclavicular lymph nodes. There is no 4th fascia in this scapuloclavicular triangle. The 5th fascia is prevertebral, poorly developed and forms a sheath for the neurovascular bundle.

TOTAL FASCIA IN THE SPACLAVICULAR TRIANGLE: 1, 2, 3, X, 5.

Cellular gap: cellular space of the scapular-clavicular triangle (spatium omoclaviculare) .

3. Vascular-nerve bundle of the scapular-clavicular triangle

Between the 3rd and the 5th fascia lying behind it, the subclavian vein passes, heading from the middle of the clavicle into the prescalene space. In it, between the first rib and the clavicle, the walls of the subclavian vein are firmly fused with the fascial sheath of the subclavian muscle and the fascia of the neck. Thanks to its fixed position, the subclavian vein is accessible here for punctures and percutaneous catheterization. Sometimes, with sudden movements of the arm during heavy physical activity, the subclavian vein can be compressed between the clavicle and the subclavian muscle and the first rib, with the subsequent development of acute thrombosis of both the subclavian and axillary veins (Paget-Schretter syndrome). Clinical manifestations of the syndrome are swelling and cyanosis of the limb. A pronounced pattern of veins is determined on the shoulder and front surface of the chest.

In the scapuloclavicular triangle, under the 5th fascia, partly above the clavicle, there are 3 arteries: a. suprascapularis, a. cervicalis superficialis and a. transversa colli, with the superficial cervical and suprascapular arteries running behind the upper edge of the clavicle in front and below the trunks of the supraclavicular part of the brachial plexus plexus brachialis, and the transverse artery of the neck passes between the trunks of this plexus. The subclavicular artery and brachial plexus enter the scapular-clavicular triangle from the interscalene space. The 5th fascia forms the sheath for the brachial plexus and artery. The subclavian artery (3rd section) lies on the 1st rib immediately outward from the scalene tubercle and descends along the anterior surface of the 1st rib, thus located between the clavicle and the 1st rib. In the third section a. subclavia can be pressed to stop bleeding to the first rib behind tuberculum m. scaleni.

Projections. The subclavian artery projects to the middle of the clavicle. The subclavian vein is projected medial to the artery, the projection line of the brachial plexus runs superiorly from the border between the lower and middle third of the sternocleidomastoid muscle at an angle to the clavicle lateral to the artery.

4. Scapular-trapezoidal triangle (trigonum omotrapezoideum)

Borders: from below it limits the scapular-hyoid muscle (m. omohyoideus), in front - the posterior edge of the sternocleidomastoid muscle, behind - the anterior edge of the trapezius muscle.

External landmarks: the anterior edge of the trapezius mouse and the posterior edge of the sternocleidomastoid mouse above the greater supraclavicular fossa.

Layers and 5. Vascular-nervous formations.

The skin is thin and mobile. In the subcutaneous tissue of the triangle there are branches of the cervical plexus - the supraclavicular nerves, nn. supraclaviculares, innervating the skin of the neck and shoulder girdle.

The superficial fascia covers the entire triangle. Flatysma covers only the anterior inferior part of the triangle. The next layer, as in all other triangles, is the superficial plate of the fascia of the neck (2nd fascia). There is neither the 3rd nor 4th fascia in this triangle.

In the tissue between the 2nd and 5th fascia there is an accessory nerve, n. accessorius, innervating the sternocleidomastoid and trapezius muscles.

The transversely running superficial cervical artery and vein also emerge from under the sternocleidomastoid muscle. These vessels, as well as the accessory nerve, lie on the 5th fascia. In the same layer along the accessory nerve there are lymph nodes that collect lymph from the tissues of the lateral region of the neck.

The 5th, prevertebral fascia covers the anterior and middle scalene muscles. Between these muscles, the cervical and brachial plexuses, plexus cervicalis and plexus brachialis, also lying under the 5th fascia, are formed.

TOTAL FASCIA IN THE Scapular-TRAPEZIOUS TRIANGLE: 1, 2, X, X, 5.