clavicular artery. Big Medical Encyclopedia

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. It leaves the chest cavity through the apertura superior, approaches 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: first- from the starting point to the entrance to the spatium interscalenum, second- in spatium interscalenum and the 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 of the occipital bone into the cranial cavity. In the cranial cavity, the vertebral arteries of both sides converge to the midline and near the posterior edge of the bridge merge into one unpaired basilar artery, a. basilaris.
On its way, it gives off 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 leaves 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 departs from the 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 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;
c) a. Cerebelli inferior posterior- largest branch 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 front edge it is divided into two aa. cerebri posteriores (one on each side), which go back and up, go around the lateral surface of the legs of the brain and branch out on the lower, inner and outer surfaces of the occipital lobe.
Taking into account the aa described above. communicantes posteriores from a. carotis interna, the posterior cerebral arteries are involved in the formation of the cerebral arterial circle, circulus arteriosus cerebri. From trunk a. basilaris small branches depart to the bridge, to 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 arterial ring, which, along with circulus arteriosus cerebri - Circle of Willis arterial is important for the collateral circulation of the 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 goes to the posterior surface of the 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).

The subclavian artery is one of the main human arteries that feeds the head, upper limbs and upper body of a person. The subclavian artery is paired, that is, there is a right and left subclavian artery. For prevention, drink Transfer Factor. They begin in the 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 upper aperture of the chest, it enters the neck, leads to the interstitial space, where it lies in the same groove 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. The inner shell 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 dura mater, the artery then 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 right subclavian artery departs from the brachial trunk, the left - from the aortic arch. Each artery first goes under the clavicle above the dome of the pleura, then passes into the gap between the anterior and middle scalene muscles, goes around the 1st rib and passes into the armpit, where it is called the axillary artery.

A number of large branches depart from the subclavian artery, feeding the organs of the neck, occiput, part of the chest wall, spinal cord and brain: 1) the vertebral artery rises upward, giving branches along the course to the spinal cord and deep muscles of the neck, passes through the large occipital foramen into the cranial cavity and here with the same name artery of the opposite side forms the basilar artery; 2) the internal thoracic artery passes into the chest cavity, where it supplies the thymus gland, trachea, bronchi, pericardium, diaphragm, chest muscles, mammary gland, abdominal muscles; 3) the thyroid trunk splits into a number of branches: the inferior thyroid artery goes to the thyroid gland, the ascending cervical artery - to the scalene and deep muscles of the neck, the suprascapular artery - to the posterior muscles of the scapula; 4) the costal-cervical trunk is divided into the deep cervical artery, which supplies blood to the deep muscles of the neck, the spinal cord and the highest intercostal artery, which feeds the muscles and skin of the first and second intercostal spaces; 5) transverse artery of the neck, feeding the muscles of the neck and upper back.

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 of the occipital bone into the cranial cavity. In the cranial cavity, the vertebral arteries of both sides converge to the midline and near the posterior edge of the bridge merge into one unpaired basilar artery, a. basilaris. On its way, it gives off 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 leaves 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, from which it merges into one trunk; b) 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: 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 the thoracic region - from aa. intercos-tales 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; in) a. Cerebelli inferior posterior is the largest of the 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 front edge it is divided into two aa. cerebri posteriores (one on each side), which go back and up, go around the lateral surface of the legs of the brain and branch out on the lower, inner and outer surfaces of the occipital lobe. Taking into account the aa described above. communicantes posteriores from a. carotis interna, the posterior cerebral arteries are involved in the formation of the cerebral arterial circle, circulus arteriosus cerebri. From trunk a. basilaris small branches depart to the bridge, to 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, which runs parallel to the trunk of the common carotid artery and participates 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 circulus arteriosus cerebri, is important for the collateral circulation of the medulla oblongata.

2. Truncus thyrocervicalis, thyroid trunk, departs from a. subclavia up at the medial edge m. scalenus anterior, has a length of about 4 cm and is divided into the following branches: a) a. thyroidea inferior goes to the posterior surface of the 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 ascends along m. scalenus anterior and supplies the deep muscles of the neck; c) a. suprascapularis goes down from the trunk 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 versus beginning 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 divides 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. epigastrica superior - continues the path of 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 its 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. Its 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).

external carotid artery,a. carotis externa, is one of the two terminal branches of the common carotid artery. It separates from the common carotid artery within the carotid triangle at the level of the upper edge of the thyroid cartilage. Initially, it is located medial to the internal carotid artery, and then - lateral to it. The initial part of the external carotid artery is covered on the outside by the sternocleidomastoid muscle, and in the region of the carotid triangle - by the superficial plate of the cervical fascia and the subcutaneous muscle of the neck. Being medially from the stylohyoid muscle and the posterior belly of the digastric muscle, the external carotid artery at the level of the neck of the lower jaw (in the thickness of the parotid gland) divides into its terminal branches - the superficial temporal and maxillary arteries. On its way, the external carotid artery gives off a number of branches that radiate from it in several directions. The anterior group of branches is made up of the superior thyroid, lingual, and facial arteries. The posterior group includes the sternocleidomastoid, occipital, and posterior auricular arteries. The ascending pharyngeal artery is directed medially.

Anterior branches of the external carotid artery:

1Superior thyroid artery,a. thyreoidea superior, departs from the external carotid artery at its beginning, goes forward and downward, and at the upper pole of the thyroid lobe is divided into anterior and back [ glandular] branches, rr. anterior and posterior. The anterior and posterior branches are distributed in the thyroid gland, anastomosing on the posterior surface of each of its lobes, as well as in the thickness of the organ with the branches of the inferior thyroid artery. On the way to the thyroid gland, the following lateral branches depart from the superior thyroid artery:

1superior laryngeal artery a. laryngea superior, which, together with the nerve of the same name, pierces the thyroid-hyoid membrane and supplies blood to the muscles and mucous membrane of the larynx;

2sublingual branch, d. infrahyoldeus, - to the hyoid bone; 3) sternocleidomastoid branch, d. sternocleidomastoideus, and 4) cricothyroid branch, d. cricothyroideus, blood-supplying muscles of the same name.

2lingual artery,a. lingualis, branches off from the external carotid artery at the level of the greater horn of the hyoid bone. The artery goes below the hyoid-lingual muscle to the region of the submandibular triangle, then goes into the thickness of the muscles of the tongue and gives dorsal branches, rr. dorsdles linguae. Its final branch, penetrating to the top of the tongue, is deep artery of the tongue a. profunda linguae. Before entering the tongue, two branches depart from the lingual artery: 1) thin suprahyoid branch, d. suprahyoldeus, anastomosing along the upper edge of the hyoid bone with a similar branch of the opposite side, and 2) relatively large hyoid artery, a. sublingudlis, going to the sublingual gland and adjacent muscles.

3 .Facial artery,a. facilis, departs from the external carotid artery at the level of the angle of the mandible, 3-5 mm above the lingual artery. The lingual and facial arteries may begin in common lingual-facial trunk, truncus linguofacidlis. In the region of the submandibular triangle, the facial artery is adjacent to the submandibular gland (or passes through it), giving it glandular branches, rr. gldnduldres, then it bends over the edge of the lower jaw to the face (in front of the masticatory muscle) and goes up and forward, towards the corner of the mouth.

Branches on the neck depart from the facial artery: 1) ascending palatine artery, a. palatina ascendens, to the soft palate;

2tonsil branch, Mr. tonsilldris, to the palatine tonsil;

3submental artery, a. submentlis, following along the outer surface of the maxillohyoid muscle to the chin and neck muscles located above the hyoid bone; on the face: in the corner of the mouth 4) inferior labial artery, a. labidlis inferior, and 5) superior labial artery, a. labidlis superior. Both labial arteries anastomose with similar arteries of the opposite side; 6) angular artery a. an-guldris, - section of the facial artery to the medial corner of the eye. Here, the angular artery anastomoses with the dorsal artery of the nose, a branch of the ophthalmic artery (from the system of the internal carotid artery).

Posterior branches of the external carotid artery:1. Occipital artery,a. occipitdlis (Fig. 45), departs from the external carotid artery almost at the same level as the facial artery. Heading back, it passes under the posterior belly of the digastric muscle, and then lies in the same groove of the temporal bone. After that, the occipital artery between the sternocleidomastoid and trapezius muscles goes to the back surface of the head, where it branches in the skin of the occiput to occipital branches, rr. occipitdles, which anastomose with similar arteries of the opposite side, as well as with the muscular branches of the vertebral and deep cervical arteries (from the subclavian artery system). Lateral branches depart from the occipital artery: 1) sternocleidomastoid branches, rr. sternocleidomastoidei, to the muscle of the same name; 2) ear branch, rr. auriculdris, anastomosing with branches of the posterior auricular artery, to the auricle; 3) mastoid branch, d. mas toideus, penetrating through the hole of the same name to the solid

shell of the brain; 4) descending branch, descendens, to the muscles of the back of the neck.

2. posterior ear artery,a. auriculdris posterior, departs from the external carotid artery above the upper edge of the posterior belly of the digastric muscle and follows obliquely backwards. Her ear branch, gg. auriculdris, and occipital branch, d. occipitdlis, blood supply to the skin of the mastoid process, the auricle and the back of the head. One of the branches of the posterior auricular artery - stylomastoid artery, a. stylomastoidea, penetrates through the hole of the same name into the canal of the facial nerve of the temporal bone, where it gives posterior tympanic artery a. tympdnica posterior, to the mucous membrane of the tympanic cavity and the cells of the mastoid process. The terminal branches of the stylomastoid artery reach the dura mater of the brain.

Medial branch of the external carotid artery - ascending pharyngeal artery,a. pharyngea ascendens. This is a relatively thin vessel, departs from the internal semicircle of the external carotid artery at its beginning, rises up to the side wall of the pharynx. From the ascending pharyngeal artery depart: 1) pharyngeal branches, rr. pharyngedles, to the muscles of the pharynx and to the deep muscles of the neck; 2) posterior meningeal artery, a. meningea posterior, follows into the cranial cavity through the jugular foramen; 3) inferior tympanic artery, a. tympdnica inferior, through the lower opening of the tympanic tubule penetrates into the tympanic cavity.

Terminal branches of the external carotid artery:

1. superficial temporal artery,a. tempordlis superficid lis, is a continuation of the trunk of the external carotid artery, goes up in front of the auricle (partially covered at the level her tragus with the back of the parotid gland) into the temporal region, where its pulsation is felt above the zygomatic arch in a living person. At the level of the supraorbital margin of the frontal bone, the superficial temporal artery divides into frontal branch, Mr. fronttis, and parietal branch, d. parietdlis, feeding the supracranial muscle, the skin of the forehead and crown and anastomosing with the branches of the occipital artery. A number of branches depart from the superficial temporal artery: 1) under the zygomatic arch - branches of the parotid gland, rr. parotidei, to the salivary gland of the same name; 2) located between the zygomatic arch and the parotid duct transverse artery of the face, a. transversa faciei, to facial muscles and skin of the buccal and infraorbital regions; 3) anterior ear branches, gg. auriculares anteriores, to the auricle and external auditory meatus, where they anastomose with the branches of the posterior auricular artery; 4) above the zygomatic arch - zygomatico-orbital artery, a. zygomaticoorbitdlis, to the lateral corner of the orbit, blood supply to the circular muscle of the eye; 5) middle temporal artery, a.tempordlis media, to the temporalis muscle.

2. maxillary artery,a. maxilldris, - also the terminal branch of the external carotid artery, but larger than the superficial temporal artery. The initial part of the artery is covered from the lateral side by the branch of the lower jaw. The artery reaches (at the level of the lateral pterygoid muscle) to the infratemporal and further to the pterygopalatine fossa, where it splits into its terminal branches. According to the topography of the maxillary artery, three sections are distinguished in it: maxillary, pterygoid and pterygo-palatine. From the maxillary artery within its maxillary department depart: 1) deep ear artery a.auriculdris profunda, to the temporomandibular joint, external auditory canal and eardrum; 2) anterior tympanic artery, a. tympdnica anterior, which through the stony-tympanic fissure of the temporal bone follows to the mucous membrane of the tympanic cavity; 3) relatively large inferior alveolar artery, a. alveoldris inferior, entering the canal of the lower jaw and giving on its way dental branches, rr. dentdles. This artery leaves the canal through the mental foramen as mental artery, a. mentallis, which branches in the mimic muscles and in the skin of the chin. Before entering the canal from the inferior alveolar artery, a thin maxillary-hyoid branch, d. mylohyoideus, to the muscle of the same name and the anterior belly of the digastric muscle; 4) middle meningeal artery, a. meningea media, - the most significant of all the arteries that feed the hard shell of the brain. Penetrates into the cranial cavity through the spinous opening of the large wing of the sphenoid bone, gives there superior tympanic artery a. tympdnica superior, to the mucous membrane of the tympanic cavity, frontal and parietal branch, rr. front-tdlis et parietdlis, to the dura mater. Before entering the spinous foramen, the middle meningeal artery departs meningeal accessory branch, d. meningeus accessorius [G. accessorius], which first, before entering the cranial cavity, supplies the pterygoid muscles and the auditory tube, and then, passing through the oval opening into the skull, sends branches to the hard shell of the brain and to the trigeminal node.

Within the pterygoid region, branches supplying the masticatory muscles depart from the maxillary artery: 1) masticatory artery, a. masseterica, to the muscle of the same name; 2) temporal deep [anterior] and [temporal posterior/arteries, a. tempordlis profunda and , going into the thickness of the temporal muscle; 3) pterygoid branches, rr. pterygoidei, to the muscles of the same name; 4) buccal artery, a. buccdlis, to the buccal muscle and to the buccal mucosa; 5) posterior superior alveolar artery, a. alveoldris superior posterior, which through the openings of the same name in the tubercle of the upper jaw penetrates into the maxillary sinus and supplies its mucous membrane with blood, and its dental branches, rr. dentdles, - teeth and gums of the upper jaw.

Three terminal branches depart from the third - pterygo-palatine - department of the maxillary artery: 1) infraorbital artery, a. infraorbitdis, which passes into the orbit through the lower palpebral fissure, where it gives off branches to the lower rectus and oblique muscles of the eye. Then, through the infraorbital foramen, this artery exits through the canal of the same name to the face and supplies blood to the mimic muscles located in the thickness of the upper lip, in the region of the nose and lower eyelid, and the skin covering them. Here the infraorbital artery anastomoses with branches of the facial and superficial temporal arteries. In the infraorbital canal, branches off the infraorbital artery anterior superior alveolar arteries, aa. alveoldres superiores anteriores, giving dental branches, rr. dentdles, to the teeth of the upper jaw; 2) descending palatine artery, a. palatina descendens, - a thin vessel, which, having given at the beginning pterygoid canal artery, a. candlis pterygoidei, to the upper part of the pharynx and the auditory tube and passing through the large palatine canal, supplies the hard and soft palate with blood (ah. palatinae major et minores), anastomoses with branches of the ascending palatine artery; 3) sphenopalatine artery, a. sphe-nopalatina. passes through the opening of the same name into the nasal cavity and gives lateral posterior nasal arteries, aa. nasdles posteriores laterdles, and posterior septal branches, rr. septdles posteriores, to the nasal mucosa

carotis interna, internal carotid artery, starting from the common carotid artery, rises to the base of the skull and enters the canalis caroticus of the temporal bone. It does not give branches in the neck area; at the very beginning lies outward from a. carotis externa, corresponding to the development from the laterally located trunk of the dorsal aorta, but soon begins to enter the medial surface of the latter.

Corresponding to the curvature of the canalis caroticus, the internal carotid artery, passing vertically in it at first, then bends in the anteromedial direction and, at the apex of the temporal bone, enters the cranial cavity through the foramen lacerum; bending upward, it rises along the sulcus caroticus of the sphenoid bone, at the level of the bottom of the Turkish saddle again turns forward, passes through the thickness of the cavernous sinus and, at canalis opticus, makes the last bend upward and somewhat backward, giving here its first branch, a. ophthalmica, after which it pierces the hard and arachnoid membranes and, finally, divides into its terminal branches.

Branches a. carotis internae:

Rr. caroticotympanici, penetrating into the tympanic cavity.

A. ophthalmica, the ophthalmic artery, penetrates through the canalis opticus into the cavity of the orbit along with n. opticus, where it splits into its terminal branches. On the way in the eye socket gives a number of branches. Branches a. ophthalmica:

1. to the hard shell of the brain, anastomosing with a. meningea media (a. maxilaris branch from the a. carotis externa system);

   to the lacrimal gland a. lacrimalis;

   to the eyeball aa. ciliares, terminate in the choroid; among them a. centralis retinae, penetrates the optic nerve and branches with it in the retina;

   to the muscles of the eyeball;

   to the ages aa. palpebrales laterales et mediates;

   to the mucous membrane of the nasal cavity aa. ethmoidales anterior et posterior;

   a. supraorbitalis leaves the orbit through the incisura supraorbitalis;

   a. dorsalis nasi descends along the edge of the back of the nose.

A cerebri anterior, the anterior cerebral artery, smaller in size, goes forward and medially to the beginning of the longitudinal sulcus of the brain, bends around the knee of the corpus callosum and stretches along the inner surface of the cerebral hemisphere back to the beginning of the occipital lobe, giving off branches along the way to the cerebral cortex. At the beginning of the longitudinal groove of the brain, it connects to the artery of the same name on the other side with the help of a transverse trunk, a. communicans anterior.

A. cerebri media, the middle cerebral artery, goes lateral to the depth of the lateral sulcus of the brain, where on the surface of the insula begins to divide into branches that go to the surface of the hemispheres and supply blood to the outer surface of the frontal, temporal and parietal lobes, with the exception of the posterior parts of the brain that receive blood from the system a. vertebralis.

A. choroidea, choroid plexus artery enters the lower horn of the lateral ventricle, ending in the plexus chorioideus.

A. communicans posterior, posterior communicating artery, departs from a. carotis interna, after giving off the ophthalmic artery, goes back and flows into a. cerebri posterior (from a. vertebralis). A. communicans anterior, initial sections aa. cerebri anteriores, aa. communicantes posteriores and aa. cerebri posteriores (from a. vertebralis) form together in the subarachnoid space at the base of the brain a closed arterial ring - circulus arteriosus cerebri.

There are three pairs of jugular veins:

Internal jugular vein ( v. jugularis interna) - the largest, is the main vessel that carries blood from the cranial cavity. It is a continuation of the sigmoid sinus of the dura mater and starts from the jugular foramen of the skull with a bulbous extension (superior bulb of the jugular vein, bulbus jugularis superior). Further, it descends towards the sternoclavicular joint, being covered in front by the sternocleidomastoid muscle. In the lower parts of the neck, the vein is located in the common connective tissue sheath along with the common carotid artery and the vagus nerve, while the vein is located somewhat more superficially and lateral to the artery. Behind the sternoclavicular joint, the internal jugular vein merges with the subclavian (here there is a lower bulb of the jugular vein, bulbus jugularis inferior), forming the brachiocephalic vein.

External jugular vein ( v. jugularis externa) - smaller in diameter, located in the subcutaneous tissue, goes along the front surface of the neck, deviating laterally in the lower sections (crossing the posterior edge of the sternocleidomastoid muscle approximately at the level of its middle). This vein is well contoured when singing, screaming or coughing, collects blood from superficial formations of the head, face and neck; sometimes used for catheterization and drug administration. Below, it perforates its own fascia and flows into the subclavian vein.

Anterior jugular vein ( v. jugularis anterior) - small, formed from the saphenous veins of the chin, descends at some distance from the midline of the neck. In the lower neck, the right and left anterior jugular veins form an anastomosis called the jugular venous arch ( arcus venosus juguli). Then the vein goes under the sternocleidomastoid muscle and flows, as a rule, into the external jugular vein.

The following veins drain into the external jugular vein:

Posterior ear vein ( v. auricularis posterior), collects venous blood from the superficial plexus located behind the auricle. She is related to v. emissaria mastoidea.

Occipital vein, v. occipitalis, collects venous blood from the venous plexus of the occipital region of the head, which is supplied by the artery of the same name. It flows into the external jugular vein below the posterior auricular. Sometimes, accompanying the occipital artery, the occipital vein flows into the internal jugular vein.

suprascapular vein ( v. suprascapularis), accompanies the artery of the same name in the form of two trunks that connect and form one trunk that flows into the terminal section of the external jugular vein or into the subclavian vein.

Anterior jugular vein ( v. jugularis anterior) is formed from the skin veins of the mental region, from where it goes down near the midline, lying first on the outer surface m. mylohyoideus, and then - on the front surface m. sternohyoideus. Above the jugular notch of the sternum, the anterior jugular veins of both sides enter the interfascial suprasternal space, where they are connected to each other through a well-developed anastomosis, called the jugular venous arch ( arcus venosus juguli). Then the jugular vein deviates outward and, passing behind m. sternocleidomastoideus, flows into the external jugular vein before it flows into the subclavian vein, less often - into the latter. Alternatively, it can be noted that the anterior jugular veins of both sides sometimes merge, forming the median vein of the neck.

All venous blood from the organs of the body flows to the right, venous, half of the heart through the two largest venous trunks: the superior vena cava and the inferior vena cava. Only the own veins of the heart flow into the coronary sinus or directly into the right atrium, bypassing the vena cava.

The superior vena cava system is formed unpaired vein, right and left brachiocephalic veins, collecting venous blood from the head, neck, upper limb, walls and organs of the chest and abdominal cavities. superior vena cava it has no valves and, heading down, at the level of the II rib, it enters the cavity of the heart bag, where it flows into the right atrium.

Unpaired vein lies in the posterior mediastinum to the right of the aorta, behind the esophagus, on the right surface of the XII-IV thoracic vertebrae, passes behind the right root of the lung, goes around the right bronchus from above and flows into the superior vena cava at the point of transition of the pericardium to the superior vena cava. The unpaired vein in the abdominal cavity begins with the confluence of the right ascending lumbar vein, subcostal vein, superior phrenic veins, pericardial (3-4) and mediastinal (5-6) veins, esophageal veins (4-7), bronchial veins (2-3), IV-XI of the right posterior intercostal veins, right posterior intercostal vein, semi-unpaired vein (which also receives the veins of the esophagus, mediastinum, part of the posterior intercostal veins).

Unpaired vein- major anastomosis between superior vena cava and inferior vena cava.

The materials are published for review and are not a prescription for treatment! We recommend that you contact a hematologist at your healthcare facility!

The subclavian artery and its branches is a paired organ, since it includes two parts that feed the organs of the upper body. As part of the systemic circulation, it is an important part of the system, which must deliver blood without interruption.

Structure

The right subclavian artery arises from the brachiocephalic trunk. The base of the left side is determined by the beginning of the aortic arch. Conventionally, this artery can be divided into several parts:

• scalenus ant. Its location is defined as the distance from the origin to the inner edge of the anterior scalene muscle.
• spatium interscalenum. It is limited by the limits of the interstitial space.
• axillaris. It starts at the outer edge of the anterior scalene muscle and stretches to the axillary artery in the middle of the clavicle.

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The length of the left subclavian artery is longer - its length differs by 2-2.5 cm.

Functions

The subclavian artery transports blood through its branches to the organs. So, she interacts with the following departments:

• First: blood goes through the vertebral artery to the spinal cord - the dorsal and hard shell of the brain, as well as to the muscles. In the lower part, the supply through the thoracic artery is carried out to the diaphragm, bronchi, mediastinal tissues, and the thyroid gland. Also, nutrition is supplied to the sternum, rectus abdominis and chest.
• Second: along the costocervical trunk, blood goes to the spinal cord and muscles.
• The third: blood flows to the muscles of the shoulders and back through the transverse artery of the neck.

• Obliterating atherosclerosis and endarteritis, post-embolic and post-traumatic obliterations, as well as Takayasu's disease can contribute to occlusion. The active development of the disease in combination with thrombosis can lead to cerebral ischemia.

SUBCLAVIAN ARTERY [arteria subclavia(PNA, JNA, BNA)] - a large vessel that supplies blood to the occipital lobes of the cerebral hemispheres, the medulla oblongata, the cerebellum, the cervical spine and spinal cord, the deep muscles of the neck, partially the organs of the neck, the shoulder girdle and the upper limb.

Anatomy

Both P. a. begin in the upper mediastinum: right P. a. - from the brachiocephalic trunk (truncus brachiocephalicus), and the left one - directly from the aortic arch; therefore, it is longer than the right one and its intrathoracic part lies behind the left brachiocephalic vein (Fig. 1). P. a. pass upward and laterally, forming a slightly convex arc, around the edges of the dome of the pleura and the apex of the lung. Having reached the 1st rib, P. a. penetrates into the interstitial space (spatium interscalenum), formed by the adjacent edges of the anterior and middle scalene muscles. In the interstitial space, the artery lies on the 1st rib. Having rounded at the exit from the interstitial space I rib, P. a. passes under the collarbone and enters the axillary fossa (see), where it passes into the axillary artery (a. axillaris).

For orientation in localization of P.'s damages and. and a choice of rational operational access to it conditional division of P. is recommended and. into three sections: 1) intrathoracic - from the beginning of the vessel to the inner edge of the anterior scalene muscle, 2) interscalene - from the inner to the outer edge of the anterior scalene muscle, 3) clavicular - from the outer edge of the anterior scalene muscle to the outer edge of the first rib. P.'s trunks and. are stable in position. Of practical importance are options for the variability of the position of P. a., associated with the presence of an additional cervical rib.

P.'s trunks and. in the second and third sections they have a symmetrical arrangement and are projected from both sides to the middle of the clavicle. The bifurcation of the brachiocephalic trunk is usually projected in the region of the upper edge of the right sternoclavicular joint.

According to V. V. Kovanov and T. I. Anikina (1974), the angle of departure of the left P. a. in 90% of cases it does not exceed 90°, and the right one in 88% is equal to 30-60°. It is noted that the diameter of the right P. a. more than the left - in 72% of cases it is 10-12 mm, while the left in 62% is 7-9 mm.

In the first department on the right to the anterior wall of P. a. the right venous angle is adjacent, often intimately soldered by the fascia with P. a.; here the artery is crossed by the vagus and phrenic nerves passing in front of it. The recurrent laryngeal nerve lies behind this area, and medially, the common carotid artery originates (see). Such a syntopy of vessels and nerves in this area creates significant difficulties during operations on P. a. On the left ahead of P. a. the left brachiocephalic vein and the thoracic duct are located (see). The nerves on the left do not cross P. a., but run parallel. In the first department from P. and. the following branches depart (Fig. 2): vertebral artery (a. vertebralis), internal thoracic (a. thoracica int.) and thyroid trunk (truncus thyreocervicalis). The vertebral artery departs from P. and. directly at the place of its exit from the chest cavity and goes up, located behind the common carotid artery, along the long muscle of the neck (m. longus colli), where it enters the transverse opening of the VI cervical vertebra. The internal thoracic artery (a. thoracica int.) starts from the lower surface of P. a. at the level of origin of the vertebral artery. Heading down, the internal thoracic artery passes behind the subclavian vein, enters the chest cavity and, being covered by the transverse muscle of the chest (m. transversus thoracis) and the parietal pleura, descends parallel to the edge of the sternum along the posterior surface of the cartilages I - VII ribs. The thyroid trunk departs from the anteroposterior surface of P. a. before its entry into the interstitial space; it has a length of 1.5 cm and is immediately divided into the following branches: the lower thyroid artery (a. thyreoidea inf.); ascending cervical artery (a. cervicalis ascendens); superficial branch (g. superficialis) or superficial cervical artery (a. cervicalis superficialis); suprascapular artery (a. suprascapularis), passing along the anterior surface of the anterior scalene muscle.

In the second section from P. a., from its posterior surface, only one branch departs - the costal-cervical trunk (truncus costocervicalis), which begins in the interstitial space of P. a. and soon divides into two branches: the deep cervical artery (a. cervicalis profunda) and the highest intercostal artery (a. intercostalis suprema).

In the third department from P. and. after its exit from the interstitial space, only one branch also departs - the transverse artery of the neck (a. transversa colli), which is divided into two branches: ascending and descending.

Research methods

Research methods at various defeats of P. and. the same as other blood vessels (see Blood vessels, research methods). A wedge is widely used, methods - determining the degree of ischemic disorders in the upper limb (discoloration and venous pattern of the skin, trophic disorders, etc.), as well as palpation and auscultation of the affected area of ​​the vessel (absence of a pulse in peripheral vessels, the appearance of systolic or continuous noise, etc. .). Evaluation of functions, the state of collateral circulation in case of damage to P. a. carried out on the basis of samples of Henle, Korotkov, etc. (see Vascular collaterals). Instrumental studies (thermoplethysmo-, oscillo-, rheovasography, flowmetry, ultrasound dopplegraphy, etc.) make it possible to objectively study hemodynamics in the P.'s pool and. Contrasting rentgenol, methods allow to detect the nature of patol, changes in the vessel (partial or complete occlusion, violation of integrity, the nature of the aneurysm, the size of the aneurysmal sac, the ways of inflow and outflow of blood in it, etc.), and also to objectively study the existing ways of collateral circulation. Rarely used radioisotope angiography (see).

Pathology

Developmental defects. Along with the angiodysplasias inherent in all blood vessels (see. Blood vessels, malformations), a significant role in disturbance of blood supply of P. and. play various anomalies. So, some anomalies of P.'s discharge and. cause a prelum of a gullet, a cut is found out radiologically in the form of a triangular defect of its filling (fig. 3). Clinically, this is manifested by a constant difficulty in passing food through the esophagus. Occasionally there is patol, tortuosity of the right P. a., accompanied by ischemic disorders in the upper limb (weakening of the pulse on the radial artery, decreased sensitivity, periodic pain in the muscles of the arm, especially during exercise). The same symptomatology is observed in the presence of additional, or so-called. cervical, ribs, with syndromes of large and small pectoral muscles, accompanied by compression of the lumen of P. a. Treatment is usually surgical. The prognosis is favorable.

Damage P. a. are the most common type of her pathology. Extremely seldom at a prelum of a thorax P.'s separation is observed and. from the aorta (usually in combination with damage to the spine, main bronchus, lung, etc.). A complete interruption of the subclavian vessels, the brachial plexus occurs when the entire upper limb is torn off along with the scapula. Such an injury, observed when: getting a hand into a rotating device, usually leads to the development of shock (see); due to a drop in ADH, the closure of the lumen of the ends of the artery: and the vein with crushed edges of their walls may not cause severe bleeding.

P.'s wounds and. in the Great Patriotic War of 1941 - 1945. accounted for 1.8% of the total number of injuries of the main arteries, and in 30.3% of cases there was also a simultaneous injury to the nerves. According to B. V. Petrovsky, with wounds P. a. damage to the lungs and pleura was observed in 77% of cases. More than Vg wounds P. a. were combined with gunshot fractures of bones - the collarbone, ribs, humerus, scapula, etc. Approx. 75% of damage to the subclavian vessels accounted for injuries only to the artery, the simultaneous injury of the subclavian artery and vein was approx. 25%; external bleeding at wound only P. and. was observed in 41.7% of cases, with a combined injury of the artery and vein in 25.8%. The resulting internal bleeding (into the pleural cavity) ended, as a rule, with a fatal outcome. Damages of various departments of P. and. have some features. So, wounds in the first section of P. a., often together with a vein, are the most life-threatening. At damages of the left P. and. sometimes there is also an injury and the thoracic duct (see); damages in the second department more often., than defeats in other departments, are followed by a trauma of a brachial texture (see). Pulsating hematoma (see) after P.'s wounds and. developed in 17.5% of cases.

In peacetime, according to the statistics of specialized clinics of the Military Medical Academy, P.'s wounds and. account for 4% of injuries of all arteries, in 50% of cases they are combined with damage to the brachial plexus. Variety of the combined damages of P. and. and other anatomical formations causes the following features of their wedge, manifestations. 1. Threatening massive primary bleeding (see), especially when the vessel is injured in the first section. 2. Frequent arrosive bleeding, the cause of which is suppuration of the wound channel, damage to the walls of the vessel by fragments of shells, bone fragments, osteomyelitis, with pulsating hematomas P. a. can lead to rapid death of the victim. 3. The constant possibility of rupture of the arterial aneurysmal sac, requiring careful monitoring of all changes in its size (the sudden increase in the sac is a reliable and objective sign of rupture) and hemodynamics. 4. Formed aneurysm P. a. manifested by classical signs (see Aneurysm): the appearance of systolic (with arterial) or continuous systolic-diastolic (with arteriovenous) noise, disappearing with compression of the proximal end; change in pulse on the radial artery; the appearance of an arteriovenous aneurysm of an expanded venous pattern on the arm, shoulder girdle, chest wall, including in the subclavian region (see); a progressive increase in autonomic disorders (impaired sweating, trophism of the skin, nails, hair growth, etc.), especially in the presence of paresis, paralysis and other damage to the brachial plexus (see). With arteriovenous aneurysm, which has arisen due to the constant discharge of arterial blood into the venous bed, patol, blood circulation causes an increased load on the myocardium with the development of cardiac decompensation. Yu. Yu. Dzhanelidze found that in the pathogenesis and dynamics of its development, the so-called. fistulous circle, i.e., the distance between the aneurysmal sac and the cavities of the heart; the shorter it is (especially when the aneurysm is localized on P. a., carotid arteries), the faster cardiac decompensation occurs.

For all types of damage to P. a., if there is no self-stopping of bleeding or self-healing of the aneurysm, surgery is indicated.

Diseases. P.'s inflammatory process and. - arteritis (see), aortoarteritis - is clinically shown by an occlusive syndrome (see. Obliterating defeats of vessels of extremities), arises as a result of hl. arr. atherosclerosis. A diffuse lesion of the vessel is possible, but the most common variant is occlusion of the first section of P. a. At the same time, signs of ischemia of the hand develop, and with occlusion and the vertebral artery - symptoms of insufficient blood supply to the brain: headache, dizziness, staggering, nystagmus (see), etc. With contrast rentgenol. the study reveals the absence of a contrast agent in the lumen of the vessel, a break in its shadow at the level of the mouth or a pronounced stenosis with a distally located post-stenotic expansion (Fig. 4). So called. scalene muscle syndrome is a consequence of cicatricial-inflammatory processes in the tissue of the interstitial space of the neck. It leads to P.'s occlusion and. in the second department with a typical wedge, a picture of an ischemia of a hand (see. Scalene muscle a syndrome). Sclerotic and mycotic (inf. of nature or embolic) aneurysms of P. and are rather rare. Unlike usual atherosclerotic occlusions, at to-rykh morfol, changes occur generally in an internal cover of a vessel, at sclerotic aneurysms the elastic framework of an artery wall collapses that promotes its saccular expansion (fig. 5).

Mycotic aneurysms of P. and. more often occur with various heart diseases (rheumatism, endocarditis, etc.), localized in the peripheral parts of the vessel. Their aneurysmal sac is filled with thrombotic mass, from which the same microflora can be sown as from the cavities of the heart.

Acute thromboembolism P. a. usually accompanied by mitral valve stenosis complicated by left atrial thrombosis, atherosclerosis, scalene syndrome. They begin suddenly and are characterized by the rapid development of ischemia of the hand: cold and marble

pallor of the skin of the arm, muscle pain, impossibility of active movements, disappearance of the pulse on the brachial and radial arteries (see Thromboembolism).

Treatment of P.'s diseases and. conservative (see. Obliterating lesions of the vessels of the extremities, treatment) and operational.

Operations

Indications for surgery are bleeding, rupture of a pulsating hematoma or aneurysmal sac, stenosis or occlusion of P. a. with progressive ischemic and neurological disorders of the hand, and with lesions of the vertebral artery - brain disorders (see Brain, operations). As a rule, various operations are simultaneously performed on the nerves of the brachial plexus and its trunks - neurolysis (see), reconstructive operations, primarily the nerve suture (see).

Inflammatory processes on the skin in the area of ​​the surgical field may be a contraindication (see).

Anesthesia: usually one of the types of inhalation anesthesia (see), Neuroleptanalgesia (see), while, according to indications, controlled hypotension is used at certain stages of the intervention (see Artificial hypotension); less commonly used local anesthesia (see Local Anesthesia).

More than 20 operational accesses to P. are described and. The most common are the classical section, sections according to Lexer, Reich, Dobrovolskaya, Petrovsky, Akhutin, Dzhanelidze, and others (Fig. 6). Since the mid 70s. for access to the first department of P. and. began to widely use thoracotomy (see) in combination with sternotomy (see Mediastinotomy), for access to the second section - supra- and subclavian incisions (usually the clavicle does not intersect).

In the mid 70s. at limited stenoses of an atherosclerotic origin began to apply P.'s dilatation and. special catheters (see X-ray endovascular surgery). Outcomes of operations on P. and. depend not only on the intervention on the vessel, but no less on the nature of the operation on the brachial plexus and its trunks.

Bibliography: Vishnevsky A. A. and Galankin N. K. Congenital heart defects and large vessels, M., 1962; Vishnevsky A. A., Krakovsky N. I. and 3olotorevsky V. Ya. Obliterating diseases of the arteries of the extremities, M., 1972; Knyazev M. D., Mirza-Avakyan L. G. and Belorusov O. S. Acute thrombosis and embolism of the main arteries of the extremities, Yerevan, 1978; Kovanov V.V. and AnikinaT. I. Surgical anatomy of arteries of the person, M., 1974, bibliogr.; Lytkin M. I. and Kolomiets V. P. Acute trauma of the main blood vessels, L., 1973; Multivolume guide to surgery, ed. B. V. Petrovsky, vol. 10, p. 416, M., 1964; Experience of the Soviet medicine in the Great Patriotic War of 1941-4945, v. 19, M., 1955; Ostroverkhov G. E., Lubotsky D. N. and Bomash Yu. M. Operative surgery and topographic anatomy, p. 158, 375, Moscow, 1972; Petrovsky BV Surgical treatment of vascular wounds, M., 1949; Petrovsky B. V. and Milonov O. B. Surgery of aneurysms of peripheral vessels, M., 1970; Pokrovsky A. V. Clinical angiology, M., 1979; Guide to angiography, ed. P.I. X. Rabkina, M., 1977; Saveliev V. S. et al. Angiographic diagnosis of diseases of the aorta and its branches, M., 1975; Sinelnikov R. D. Atlas of human anatomy, t. 2, p. 286, 302, M., 1979; Emergency surgery of the heart and blood vessels, ed. M. E. De Beki and B. V. Petrovsky. Moscow, 1980. Hardy J. D. Surgery of the aorta and its branches, Philadelphia, 1960; R i with h N. M. a. Spencer F. C. Vascular trauma, Philadelphia, 1978; The surgical management of vascular diseases, ed. by H. Haimovici, Philadelphia, 1970.

G. E. Ostroverkhov (an.), M A. Korendyaeev (hir.).