The continuation of the subclavian artery is the artery. Occlusion of the subclavian artery. Location of the subclavian artery
Subclavian artery, a. subclavia. Branches of the first division of the subclavian artery.
Only left 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 a convex upward arc, envelope of the dome of the pleura. She leaves chest cavity through apertura superior, goes to the collarbone, lies down in sulcus a. subclaviae I rib and bends over it. Here the subclavian artery can be pressed to stop the bleeding to the 1st rib behind tuberculum m. scaleni. Further, the artery continues into the axillary fossa, where, starting from the outer edge of the 1st rib, it receives the name a. axillaris. On its way, the subclavian artery passes along with the brachial plexus through the spatium interscalenum, therefore it has 3 divisions: the first- from the starting point to the entrance to the spatium interscalenum, second- in spatium interscalenum and third- upon exiting it, before moving to a. axillaris.
Branches of the first section of the subclavian artery (before entering the spatium interscalenum):
1. 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 occipital bone into the cranial cavity. In the cranial cavity, the vertebral arteries of both sides converge to middle line and near the posterior edge of the bridge merge into one unpaired basilar artery, a. basilaris.
On her way she gives small branches to the muscles, spinal cord and hard shell of the occipital lobes of the brain, as well as large branches:
a) a. spinalis anterior departs in the cranial cavity near the confluence of two vertebral arteries and goes down and towards the midline towards the same-named artery of the opposite side, with which it merges into one trunk;
b) a. spinalis posterior moving away from vertebral artery immediately after its entry into the cranial cavity and also goes down the sides of the spinal cord. As a result, three arterial trunks descend along the spinal cord: unpaired - along the anterior surface (a. spinalis anterior) and two paired - along the posterolateral surface, one on each side (aa. spinales posteriores). All the way to the lower end of the spinal cord, they receive reinforcements in the form of rr through the intervertebral foramina. spinales: in the neck - from aa. vertebrales, in 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;
c) a. Cerebelli inferior posterior- largest branch a. vertebralis, starts near the bridge, heads back and, bypassing medulla, branches into bottom surface cerebellum.
A. basilaris, basilar artery, obtained from the fusion of both vertebrates, unpaired, lies in the median groove of the bridge, at the front edge it is divided into two aa. cerebri posteriores (one on each side), which go back and up, go around side surface legs of the brain and branch out on the lower, inner and outer surfaces occipital lobe.
Taking into account the aa described above. communicantes posteriores from a. carotis interna, rear cerebral arteries participate in the formation of the arterial circle of the brain, circulus arteriosus cerebri. From trunk a. basilaris leaves small branches to the bridge, during 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 arterial ring, which, along with circulus arteriosus cerebri - Circle of Willis arterial matters for collateral circulation medulla oblongata.
2. Truncus thyrocervicalis, thyroid trunk, moving away from a. subclavia up at the medial edge m. scalenus anterior, is about 4 cm long and is divided to the following branches:
a) a. thyroidea inferior heading towards rear surface thyroid gland, gives 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 branches a. thyroidea superior from system a. carotis externa;
b) a. cervicalis ascendens goes up m. scalenus anterior and supplies the deep muscles of the neck;
in) a. suprascapularis goes from the trunk down 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.
3. A. thoracica interna, internal thoracic artery, departs from a. subclavia against start a. vertebralis, goes down and medially, adjacent to the pleura; starting from the I costal cartilage, goes vertically down 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 into the nearest intercostal spaces, and a. epigastric superior- keeps going a. thoracica interna downwards, penetrates into the vagina of the rectus abdominis muscle and, having reached the level of the navel, anastomoses with a. epigastica inferior (from a. iliaca externa).
On his way a. thoracica interna gives branches to the nearest anatomical formations: the connective tissue of the anterior mediastinum, the thymus gland, the lower end of the trachea and bronchi, to the six upper intercostal spaces and the mammary gland. Her long branch a. pericardiacophrenica, together with n. phrenicus goes to the diaphragm, giving branches to the pleura and pericardium along the way. Her rami intercostales anteriores go in the upper six intercostal spaces and anastomose with aa. intercostales posteriores(from the aorta).
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Topography of vessels in the subclavian region. Subclavian artery. Topography of the subclavian artery. Nerves of the subclavian region.
subclavian arteries located under the 5th fascia. Right subclavian artery, a. subclavia dextra, departs from the humeral trunk, and the left one, a. subclavia sinistra, - from the aortic arch.
subclavian artery conditionally divided into four sections:
1) chest - from the place of discharge to the medial edge m. scalenus anterior;
2) interstitial, corresponding to the interstitial space, spatium interscalenum;
3) supraclavicular section - from the lateral edge of the anterior scalene muscle to the clavicle;
4) subclavian - from the collarbone to top edge pectoralis minor muscle. The last section of the artery is already called the axillary artery, and it is studied in the subclavian region, in the clavicular-thoracic triangle, trigonum clavipectorale.
In the first section, the subclavian artery lies on the dome of the pleura and is connected with it by connective tissue strands.
On the right side neck in front of subclavian artery situated Pirogovsky venous angle - the confluence of the subclavian vein and the internal jugular vein.
On the front surface subclavian artery n descends transversely to it. vagus, from which n departs here. laryngeus recurrens, bending around the artery from below and behind and rising upward in the angle between the trachea and esophagus (Fig. 6.19). Outside of the vagus nerve, the artery is crossed by n. phrenicus dexter. Between the vagus and phrenic nerves is the subclavian loop of the sympathetic trunk, ansa subclavia, covering the subclavian artery with its constituent branches.
Inward from the subclavian artery passes through the right common carotid artery.
On the left side of the neck first subclavian artery lies deeper and is covered by the common carotid artery. The left subclavian artery is about 4 cm longer than the right. Anterior to the left subclavian artery is the internal jugular vein and the origin of the left brachiocephalic vein. Between these veins and the artery pass n. vagus and n. phrenicus sinister, but not transversely to the artery, as on the right side, but along its anterior wall (n. vagus - inside, n. phrenicus - outside, ansa subclavia - between them).
Medial to the subclavian artery are the esophagus and trachea, and in the groove between them - n. laryngeus recurrens sinister (it departs from the vagus nerve much lower than the right one, at the lower edge of the aortic arch). Between the left subclavian and common carotid arteries, bending around the subclavian artery behind and above, passes the ductus thoracicus.
Subclavian artery (a. subclavia) - a large paired vessel, is 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 departs from the brachiocephalic trunk (truncus brachiocephalicus), the left - directly from the aortic arch (arcus aortae), so the left one is 4 cm longer than the right one. Three sections are distinguished along the course of the subclavian artery and according to its relationship with the anterior scalene muscle.
On its way, the subclavian artery passes along with the brachial plexus through the spatium interscalenum, formed by the adjacent surfaces of the anterior and middle scalene muscles, and passes along the 1st rib into sulcus a. subclaviae. Therefore, 3 sections are topographically distinguished in the subclavian artery: 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 scale-vertebral gap (spatium scalenovertebrale), the second - limited by the limits of the interscalene gap (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 against the I rib behind tuberculum m to stop bleeding. scaleni.
The 1st subclavian artery gives three important branches:
vertebral (a. vertebralis), thyroid trunk (truncus thyrocervicalis), internal thoracic artery (a. thoracica interna). As well as branches from the thyroid trunk (truncus thyreocervicalis): the lower thyroid artery (a. thyroidea inferior), and its branch - the ascending cervical artery (a. cervicalis ascendens), superficial cervical artery (a. cervicalis superficialis), suprascapular artery (a. suprascapularis). The suprascapular artery (a. suprascapularis) is involved in the formation of the scapular arterial circle.
The 2nd division 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 back of the 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 perforates the plexus brachialis, supplies neighboring muscles and descends along the medial edge of the scapula to its lower angle. All elements of the subclavian neurovascular bundle are connected together to pass into the axillary fossa on the upper limb.
Shoulder plexus.
The brachial plexus, plexus brachialis, is composed of the anterior branches of the four lower cervical nerves and most of the first thoracic; often a thin branch from C111 joins. The brachial plexus exits through the gap between the anterior and middle scalene muscles into the supraclavicular fossa, located above and behind a. subclavia. Three thick nerve bundles arise from it, going into the axillary fossa and surrounding a. axillaris from three sides: from the lateral (lateral bundle), medial (medial bundle) and posterior to the artery ( posterior beam). In the plexus, the supraclavicular (pars supraclavicularis) and subclavian (pars infraclavicularis) parts are usually distinguished. Peripheral branches are divided into short and long. Short branches go to various places plexus in its supraclavicular part and partly supply the muscles of the neck, as well as the muscles of the girdle of the upper limb (with the exception of m. trapezius) and shoulder joint. Long branches originate 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 opposite direction from the surgeon and is taken up. 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.
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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 - trapezoid triangle. 5. Vascular - nerve formations. 6. Projection on the skin of the subclavian artery, online 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 of the lateral (rear) edge m. sternocleidomastoideus, behind - the anterior edge of the trapezius muscle (musculus trapezius), below - the clavicle (clavicula).
By the lower abdomen, 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 the 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 back. The clavicle limits the area from below.
2. Scapular-clavicular triangle (trigonum omoclaviculare).
Borders: triangle lower bound is the clavicle, the front is the posterior edge of the sternocleidomastoid muscle, the upper-posterior border is the projection line of the lower abdomen of the scapular-hyoid muscle (m. omohyoideus).
External landmarks: large supraclavicular fossa, fossa supraclavicularis major.
Layers and fasciae: Skin, subcutaneous fat, fascia. The skin of the scapular-clavicular triangle is thin and mobile. The superficial fascia and platysma of the scapular-clavicular triangle cover the entire triangle, as does the superficial lamina of the fascia of the neck (2nd fascia). Between the 1st and 2nd fascia in lower section scapular-clavicular triangle, along the posterior edge of the sternocleidomastoid muscle, passes v. jugularis externa. It perforates the 2nd and 3rd fascia and flows into the confluence angle of the subclavian and internal jugular veins or a common trunk with the internal jugular vein into the subclavian. The adventitia of the vein is associated with the fascia that it perforates, so it gapes when injured. At the same time, along with profuse bleeding possible air embolism. The pretracheal plate of the fascia of the neck (3rd fascia) is located below m. omohyoideus, behind the 2nd fascia of the neck. Together with her, she is attached to the collarbone. Behind the 3rd fascia in the scapular-clavicular triangle is an abundant layer of fatty tissue containing supraclavicular The lymph nodes. There is no 4th fascia in this scapular-clavicular triangle. The 5th fascia is prevertebral, poorly developed and forms a sheath for the neurovascular bundle.
TOTAL FASCIA IN THE BULDOCLAVIC TRIANGLE: 1, 2, 3, X, 5.
Cell 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 to the prescalene space. In it, between the 1st rib and the clavicle, the walls of the subclavian vein are firmly fused with the fascial sheath of the subclavian muscle and the fasciae of the neck. Thanks to the fixed position, the subclavian vein is available here for punctures and percutaneous catheterization. Sometimes, with sudden movements of the arm during heavy physical exertion, the subclavian vein can be compressed between the clavicle and the subclavian muscle and the 1st rib, followed by the development of acute thrombosis of both the subclavian and axillary veins (Paget-Schretter syndrome). Clinical manifestations syndrome are edema and cyanosis of the extremity. A pronounced pattern of veins is determined on the shoulder and anterior surface of the chest.
In the scapular-clavicular triangle, under the 5th fascia, partly above the clavicle, there are 3 arteries: a. suprascapularis, a. cervicalis superficialis and a. transversa colli, and the superficial cervical and suprascapular arteries run behind the upper edge of the clavicle anteriorly 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. subclavian artery and brachial plexus in the scapular - clavicular triangle pass from the interstitial 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 down the anterior surface of the 1st rib, thus being located between the clavicle and the 1st rib. In the third section a. subclavia can be pressed to stop bleeding to the 1st rib behind tuberculum m. scaleni.
Projections. The subclavian artery projects to the middle of the clavicle. The subclavian vein is projected medially to the artery, the projection line of the brachial plexus runs from above from the border between the lower and middle thirds of the sternocleidomastoid muscle at an angle to the clavicle lateral to the artery.
4. Scapular - trapezoid 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 and the posterior edge of the sternocleidomastoid above the greater supraclavicular fossa.
Layers and 5. Vascular - nerve formations.
The skin is thin, mobile. subcutaneous tissue triangle go branches of the cervical plexus - supraclavicular nerves, nn. supraclaviculares, innervating the skin of the neck and shoulder girdle.
The superficial fascia covers the entire triangle. Flatysma covers only the anteroinferior part of the triangle. The next layer, as in all other triangles, is the superficial plate of the fascia of the neck (2nd fascia). Neither the 3rd nor the 4th fascia is present in this triangle.
In the fiber between the 2nd and 5th fascia passes the accessory nerve, n. accessorius, which innervates the sternocleidomastoid and trapezius muscles.
From under the sternocleidomastoid muscle, there are also transverse superficial cervical arteries and veins. 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 SHOULDER-TRAPEZIOID TRIANGLE: 1, 2, X, X, 5.
The subclavian artery is one of the main human arteries that feeds the head, upper limbs and upper part human torso. The subclavian artery is paired, that is, there is a right and left subclavian artery. For prevention, drink Transfer Factor. They start at anterior mediastinum. The right one originates from the brachiocephalic trunk, and the left one - directly from the aortic arch. Therefore, the left subclavian artery is longer than the right, by about 4 cm.
The artery forms an arch convex upwards, enveloping the dome of the pleura. Then through the top aperture chest goes to the neck, leads to the interstitial space, where it lies in the groove of the same name of the first rib and below the lateral edge of this rib passes into the axillary cavity and continues like the axillary artery.
The walls of the subclavian artery consist of three membranes: internal, middle and external. Inner shell It is formed from the endothelium and the pidendothelial layer. The middle shell consists of smooth muscle cells and elastic fibers, the ratio of which to each other is approximately the same. External - the shell is formed by loose fibrous connective tissue, which contains bundles of smooth myocytes, elastic and collagen fibers. It contains vessels of blood vessels that provide trophic function.
In the subclavian artery, three sections are topographically distinguished: the first - from the place of origin to the interstitial space, the second - in the interstitial space, and the third - from the interstitial space to the upper opening of the axillary cavity. In the first section, three branches depart from the artery: the vertebral and internal thoracic arteries, the thyroid trunk, in the second section - the costocervical trunk, and in the third - sometimes the transverse artery of the neck.
The vertebral artery, whose normal lumen is 1.9 mm–4.4 mm, is considered a branch of the subclavian artery. The vertebral artery is the most significant of the branches of the subclavian artery. It starts from its upper surface, flows into the transverse foramen of the sixth cervical vertebra and lies in the canal, which arose due to the holes in the transverse processes of the cervical vertebrae. The vertebral vein runs along with the artery. From the transverse opening of the first cervical vertebra, the vertebral artery emerges and goes in its groove. Having passed the posterior atlanto-occipital membrane and the hard meninges, the artery further lies through the foramen magnum and the posterior cranial fossa. Here begins its intracranial part. Behind the pons of the brain, this artery joins with a similar artery on the opposite side, forming the basilar artery, which is unpaired. Continuing its path, the basilar artery is adjacent to the basilar groove and the lower surface of the bridge at its anterior edge.
In the cranial cavity, the following depart from the vertebral artery: the anterior spinal artery - right and left, the paired posterior spinal artery and the posterior inferior cerebellar artery, which branches on the lower surface of the cerebellar hemisphere.
The subclavian artery is paired organ, consisting of the right and left subclavian arteries, supplying blood to the arm and neck.
She is part of great circle blood circulation and originates in the anterior mediastinum: the right subclavian artery comes from the brachiocephalic trunk, being its final branch, while the left one departs from the aortic arch. The left subclavian artery is longer than the right: its intrathoracic part lies behind the brachiocephalic vein.
The direction of the subclavian artery in relation to the upper aperture of the chest lies laterally and upwards, forming a slightly convex arc, enveloping the apex of the lung and the dome of the pleura.
Having reached the I rib, the subclavian artery enters the interstitial space, which is formed by the adjacent surfaces of the middle and anterior scalene muscles. In the specified interval on it is the brachial plexus.
Having rounded the 1st rib, the subclavian artery goes under the clavicle and enters the axillary cavity, where it is already called the axillary artery.
There are three main sections of the left and right subclavian arteries:
- The first. It originates from the place of its formation to the entrance to the interstitial space;
- Second. Begins in the interstitial space;
- Third. It starts at the exit from the interstitial space up to the entrance to the axillary cavity.
The following branches of the subclavian artery depart from the first section:
- Vertebral artery (a.vertebralis). Her path lies through the opening of the transverse process of the sixth cervical vertebra, rising up and entering the cranial cavity through the foramenmagnum - a large occipital foramen. Further, it connects with the artery on the other side, forming with it the basilar artery. The function of the vertebral artery is to supply blood spinal cord, muscles and hard shell brain (its occipital lobes);
- The internal thoracic artery (a. thoracicainterna) originates from the lower surface of the subclavian artery. It supplies blood with nutrients dissolved in it. thyroid gland, main bronchi, diaphragm, sternum, chest, tissue of the anterior and upper mediastinum, as well as the chest and rectus abdominis;
- Thyrocervical trunk (truncusthyrocervicalis). It departs from the inner edge of the scalene muscle, reaching a length of about 1.5 cm, and is divided into several branches that supply blood to the mucous membrane of the larynx, neck muscles and scapula.
The second division of the subclavian artery has only one branch: the costocervical trunk (truncus costocervicalis). It originates on the posterior surface of the subclavian artery and is also divided into several branches: the deep cervical artery and the highest intercostal artery, from which the posterior (leading to the back muscles) and spinal branches depart.
The branch of the third division of the subclavian artery is the transverse artery of the neck, penetrating the brachial plexus and subdividing into the superficial artery, supplying blood to the muscles of the back, the deep branch of the subclavian artery and the dorsal artery of the scapula, which descends down to the wide back muscle, feeding it and the accompanying small muscles.
Subclavian artery lesions
Stenosis (narrowing of the lumen) is the main disease affecting the subclavian artery and its branches.
Stenoses, most often, are the result of atherosclerotic changes in the vessels or thrombosis. The causes of acquired (not congenital) stenosis of the subclavian artery are disorders metabolic processes in the body, inflammatory diseases and neoplasms.
Deposits on the walls of blood vessels that clog the artery have a lipid base, being, in fact, derivatives of cholesterol.
Narrowing or stenosis of the subclavian artery, which reduces about 80% of the lumen of the vessel, leads to a decrease in volumetric blood flow, which leads to a very negative effect - a shortage of tissues that are supplied with blood from the subclavian artery, nutrients and oxygen.
Arterial stenosis is often accompanied by the appearance of atherosclerotic plaques that can completely block the flow of blood in the artery and increase the likelihood of ischemic stroke.
The main complaint of patients with stenosis of the subclavian artery: pain, aggravated by physical activity predominantly on the side of the affected limb.
Treatment
The main methods of treatment of stenosis of the subclavian arteries are:
- X-ray endovascular stenting;
- Carotid subclavian bypass.
Carotid-subclavian shunting is performed in patients with a hypersthenic constitution (in whom the isolation of 1 section of the subclavian artery is associated with certain difficulties), as well as when stenosis is detected in the second section of the subclavian artery.
X-ray endovascular stenting has great advantages over open surgical intervention: the operation is performed under local anesthesia through a small (2-3 mm) incision on the skin through the puncture hole.