From its origin, the subclavian artery travels laterally, passing between anterior and middle scalene muscles, with the anterior scalene on its anterior side and the middle scalene on its posterior. This is in contrast to the subclavian vein, which travels anterior to the anterior scalene. As the subclavian artery crosses the lateral border of the first rib, it becomes the axillary artery.
On the right side, the subclavian artery arises from the brachiocephalic (innominate) artery behind the right sternoclavicular articulation; on the left side it springs from the arch of the aorta. The two vessels, therefore, in the first part of their course, differ in length, direction, and relation with neighboring structures. The left subclavian artery is around 9 cm long in adults, while the right subclavian artery is around 6 cm long. Both have a width of 9-12 mm.
In order to facilitate the description, each subclavian artery is divided into three parts:
The first portions of the two vessels require separate descriptions; the second and third parts of the two arteries are practically alike.
The first part of the right subclavian artery arises from the brachiocephalic trunk, behind the upper part of the right sternoclavicular articulation. It passes upward and lateralward to the medial margin of the scalenus anterior muscle. It ascends a little above the medial part of the clavicle.
The second portion of the subclavian artery lies behind the scalenus anterior muscle and in front of the scalenus medius muscle. It is very short, and forms the highest part of the arch described by the vessel.
In front, it is covered by the skin, the superficial fascia, the platysma muscle, the deep cervical fascia, the sternocleidomastoid muscle, and the scalenus anterior muscle. On the right side of the neck, the phrenic nerve is separated from the second part of the artery by the scalenus anterior muscle, while on the left side it crosses the first part of the artery close to the medial edge of the muscle. Behind the artery are the pleura and the scalenus medius muscle. Above the artery is the brachial plexus. Below the artery is the pleura. The subclavian vein lies below and anterior to the artery, separated from it by the scalenus anterior muscle.
The third portion of the subclavian artery runs downward and lateralward from the lateral margin of the scalenus anterior muscle to the outer border of the first rib, where it becomes the axillary artery. This is the most superficial portion of the vessel, and is contained in the subclavian triangle.
It is covered, in front, by the skin, the superficial fascia, the platysma muscle, the supraclavicular nerves, and the deep cervical fascia. The external jugular vein crosses its medial part and receives the transverse scapular, transverse cervical, and anterior jugular veins, which frequently form a plexus in front of the artery. Behind the veins, the nerve to the Subclavius descends in front of the artery. The terminal part of the artery lies behind the clavicle and the Subclavius and is crossed by the transverse scapular vessels. The subclavian vein is in front of and at a slightly lower level than the artery. Behind, it lies on the lowest trunk of the brachial plexus, which intervenes between it and the scalenus medius muscle. Above and to its lateral side are the upper trunks of the brachial plexus and the omohyoid muscle. Below, it rests on the upper surface of the first rib.
Essentially, the 4th aortic arch and dorsal aorta form the aortic arch on the left, but since the right dorsal aorta regresses distal to the right 7th intersegmental artery, on the right they form the proximal portion of the subclavian artery. Since the left subclavian is then a tributary of the left common carotid, they can be thought of as arising from the brachiocephalic trunk.
The subclavian arteries vary in their origin, their course, and the height to which they rise in the neck.
The origin of the right subclavian from the innominate takes place, in some cases, above the sternoclavicular articulation, and occasionally, but less frequently, below that joint. The artery may arise as a separate trunk from the arch of the aorta, and in such cases it may be either the first, second, third, or even the last branch derived from that vessel; in the majority, however, it is the first or last, rarely the second or third. When it is the first branch, it occupies the ordinary position of the innominate artery; when the second or third, it gains its usual position by passing behind the right carotid; and when the last branch, it arises from the left extremity of the arch, and passes obliquely toward the right side, usually behind the trachea, esophagus, and right carotid, sometimes between the esophagus and trachea, to the upper border of the first rib, whence it follows its ordinary course. In very rare instances, this vessel arises from the thoracic aorta, as low down as the fourth thoracic vertebra. Occasionally, it perforates the anterior scalene; more rarely it passes in front of that muscle. Sometimes the subclavian vein passes with the artery behind the Scalenus anterior. The artery may ascend as high as 4 cm. above the clavicle, or any intermediate point between this and the upper border of the bone, the right subclavian usually ascending higher than the left.
The left subclavian is occasionally joined at its origin with the left common carotid artery, forming a left brachiocephalic trunk.
The left subclavian artery is more deeply placed than the right in the first part of its course, and, as a rule, does not reach quite as high a level in the neck. The posterior border of the sternocleidomastoid corresponds pretty closely to the lateral border of the anterior scalene, so that the third portion of the artery, the part most accessible for operation, lies immediately lateral to the posterior border of the sternocleidomastoid.
Some authors describe the subclavian artery as arising from the 7th intersegmental artery.
The subclavian arteries carry most of the blood that supplies the arms. It also supplies some blood to the neck and brain.
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