Brachiocephalic artery

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Brachiocephalic artery.
Gray506.svg
Schematic of the proximal aorta, frontal view. The brachiocephalic artery is the third branch of the aorta and the first branch from the arch of the aorta. The heart in the lower left is not shown.
Relations of the aorta, trachea, esophagus and other heart structures.png
Course of the ascending aorta (anterior view), as it passes dorsally to the pulmonary trunk but ventrally to the right pulmonary artery.
Details
Precursor Right horn of aortic sac
Source Aortic arch
BranchesRight common carotid artery
Right subclavian artery
Thyroid ima artery (occasionally)
Vein Brachiocephalic vein
Identifiers
Latin truncus brachiocephalicus
MeSH D016122
TA98 A12.2.04.004
TA2 4179
FMA 3932
Anatomical terminology

The brachiocephalic artery, brachiocephalic trunk, or innominate artery is an artery of the mediastinum that supplies blood to the right arm, head, and neck. [1] [2]

Contents

It is the first branch of the aortic arch. [3] Soon after it emerges, the brachiocephalic artery divides into the right common carotid artery and the right subclavian artery. [4]

There is no brachiocephalic artery for the left side of the body. The left common carotid artery and the left subclavian artery come directly off the aortic arch. Despite this, there are two brachiocephalic veins. [5]

Structure

The brachiocephalic artery arises on a level with the upper border of the second right costal cartilage from the start of the aortic arch [3] on a plane anterior to the origin of the left carotid artery. It ascends obliquely upward, backward, and to the right to the level of the upper border of the right sternoclavicular articulation, where it divides into the right common carotid artery and right subclavian arteries. The artery then crosses the trachea in front of it obliquely from the left to the right, roughly at the middle of the trachea or the level of the ninth tracheal cartilage.

Relations

The brachiocephalic artery has relation with: [6]

The thymus typically sits atop the brachiocephalic artery, and it separates the artery from the posterior surface of the manubrium of sternum. [4]

Branches

The thyroid ima artery ascends in front of the trachea to the lower part of the thyroid, which it supplies.

Variation

The innominate artery usually gives off no branches, but occasionally a small branch, the thyroid ima artery, arises from it. Other times, it gives off a thymic or bronchial branch.

Thyroid ima artery varies greatly in size, and appears to compensate for deficiency or absence of one of the other thyroid vessels. It occasionally arises from the aorta, the right common carotid, the subclavian or the internal mammary.

Development

The aortic sac is the embryological precursor of the proximal portion of the aortic arch. It is chronologically the first portion of the aorta to form, and appears as a dilation superior to the truncus arteriosus. Between the two horns of aortic sac, right horn gives rise to the brachiocephalic artery. Then the right horn fuses with the right-sided third and fourth aortic arches, which give rise to the right common carotid artery and the proximal right subclavian artery respectively. [4] Eventually, brachiocephalic artery is derived from ventral aorta, same as ascending aorta. Left horn forms proximal ascending portion of aorta. [7]

Function

The brachiocephalic artery sends blood from the heart to the right arm, head, and neck. [8] Oxygenated blood from the aortic trunk is taken through the brachiocephalic artery into the right subclavian artery, which transports blood to the right arm, and into the right common carotid artery, where blood is transported to the head and neck. [9]

Clinical significance

Innominate artery aneurysms represent 3% of all arterial aneurysms. Because there is a risk of thromboembolic complications and spontaneous rupture, surgical repair is usually recommended early on after discovery. Innominate artery aneurysms often present with signs of innominate artery compression syndrome and have a very high risk of rupture. [10] The majority of IA aneurysms are due to atherosclerosis. Other causes include syphilis, tuberculosis, Kawasaki's disease, Takayasu's arteritis, Behçet's disease, connective tissue disease, and angiosarcoma. [10]

Tracheoinnominate fistula (TIF) is a surgical emergency with high mortality rates. Reported incidence is 0.1%-1.0% after tracheostomy. TIF is usually fatal once it bleeds. For the successful management of TIF, treatment should be initiated immediately with special considerations kept in mind. [11]

Several abnormalities of the brachiocephalic artery have been reported. A retroesophageal innominate artery is a rare congenital anomaly. [12] Also, aberrant innominate artery crossing anterior to the trachea just below the thyroid isthmus was reported. Anterior neck surgeries such as bronchoscopies and mediastinoscopies are common and safe procedure, since operating around the trachea, no major vessel is encountered in the surgical field. However, when this type of abnormality is encountered, even minor trauma can lead to mass bleeding culminating in death. [13] Aberrant innominate artery can cause incomplete vascular ring. It does not completely encircle the trachea and esophagus, but some compress either the trachea or esophagus. Anomalous innominate artery originates later from the transverse arch and then crosses the trachea causing anterior tracheal compression. [14]

Additional images

See also

Related Research Articles

<span class="mw-page-title-main">Aorta</span> Largest artery in the human body

The aorta is the main and largest artery in the human body, originating from the left ventricle of the heart, branching upwards immediately after, and extending down to the abdomen, where it splits at the aortic bifurcation into two smaller arteries. The aorta distributes oxygenated blood to all parts of the body through the systemic circulation.

<span class="mw-page-title-main">Brachiocephalic vein</span> Vein

The left and right brachiocephalic veins are major veins in the upper chest, formed by the union of the ipsilateral internal jugular vein and subclavian vein behind the sternoclavicular joint. The left brachiocephalic vein is more than twice the length of the right brachiocephalic vein.

<span class="mw-page-title-main">Subclavian artery</span> Major arteries of the upper thorax, below the clavicle

In human anatomy, the subclavian arteries are paired major arteries of the upper thorax, below the clavicle. They receive blood from the aortic arch. The left subclavian artery supplies blood to the left arm and the right subclavian artery supplies blood to the right arm, with some branches supplying the head and thorax. On the left side of the body, the subclavian comes directly off the aortic arch, while on the right side it arises from the relatively short brachiocephalic artery when it bifurcates into the subclavian and the right common carotid artery.

<span class="mw-page-title-main">Thoracic duct</span> Lymphatic vessel

In human anatomy, the thoracic duct is the larger of the two lymph ducts of the lymphatic system. The thoracic duct usually begins from the upper aspect of the cisterna chyli, passing out of the abdomen through the aortic hiatus into first the posterior mediastinum and then the superior mediastinum, extending as high up as the root of the neck before descending to drain into the systemic (blood) circulation at the venous angle.

<span class="mw-page-title-main">Vascular surgery</span> Medical specialty, operative procedures for the treatment of vascular disorders

Vascular surgery is a surgical subspecialty in which vascular diseases involving the arteries, veins, or lymphatic vessels, are managed by medical therapy, minimally-invasive catheter procedures and surgical reconstruction. The specialty evolved from general and cardiovascular surgery where it refined the management of just the vessels, no longer treating the heart or other organs. Modern vascular surgery includes open surgery techniques, endovascular techniques and medical management of vascular diseases - unlike the parent specialities. The vascular surgeon is trained in the diagnosis and management of diseases affecting all parts of the vascular system excluding the coronaries and intracranial vasculature. Vascular surgeons also are called to assist other physicians to carry out surgery near vessels, or to salvage vascular injuries that include hemorrhage control, dissection, occlusion or simply for safe exposure of vascular structures.

<span class="mw-page-title-main">Internal jugular vein</span> Blood vessel that drains the head

The internal jugular vein is a paired jugular vein that collects blood from the brain and the superficial parts of the face and neck. This vein runs in the carotid sheath with the common carotid artery and vagus nerve.

<span class="mw-page-title-main">Recurrent laryngeal nerve</span> Nerve in the human body

The recurrent laryngeal nerve (RLN) is a branch of the vagus nerve that supplies all the intrinsic muscles of the larynx, with the exception of the cricothyroid muscles. There are two recurrent laryngeal nerves, right and left. The right and left nerves are not symmetrical, with the left nerve looping under the aortic arch, and the right nerve looping under the right subclavian artery then traveling upwards. They both travel alongside the trachea. Additionally, the nerves are among the few nerves that follow a recurrent course, moving in the opposite direction to the nerve they branch from, a fact from which they gain their name.

<span class="mw-page-title-main">Common carotid artery</span> One of the two arteries that supply the head and neck with blood

In anatomy, the left and right common carotid arteries (carotids) are arteries that supply the head and neck with oxygenated blood; they divide in the neck to form the external and internal carotid arteries.

<span class="mw-page-title-main">Thoracic aorta</span> Part of the aorta located in the thorax

The thoracic aorta is a part of the aorta located in the thorax. It is a continuation of the aortic arch. It is located within the posterior mediastinal cavity, but frequently bulges into the left pleural cavity. The descending thoracic aorta begins at the lower border of the fourth thoracic vertebra and ends in front of the lower border of the twelfth thoracic vertebra, at the aortic hiatus in the diaphragm where it becomes the abdominal aorta.

<span class="mw-page-title-main">Aortic arch</span> Part of the aorta

The aortic arch, arch of the aorta, or transverse aortic arch is the part of the aorta between the ascending and descending aorta. The arch travels backward, so that it ultimately runs to the left of the trachea.

<span class="mw-page-title-main">Aortic arches</span>

The aortic arches or pharyngeal arch arteries are a series of six paired embryological vascular structures which give rise to the great arteries of the neck and head. They are ventral to the dorsal aorta and arise from the aortic sac.

<span class="mw-page-title-main">Aberrant subclavian artery</span> Medical condition

Aberrant subclavian artery, or aberrant subclavian artery syndrome, is a rare anatomical variant of the origin of the right or left subclavian artery. This abnormality is the most common congenital vascular anomaly of the aortic arch, occurring in approximately 1% of individuals.

<span class="mw-page-title-main">Inferior thyroid veins</span>

The inferior thyroid veins appear two, frequently three or four, in number, and arise in the venous plexus on the thyroid gland, communicating with the middle and superior thyroid veins. While the superior and middle thyroid veins serve as direct tributaries to the internal jugular vein, the inferior thyroid veins drain directly to the brachiocephalic veins.

<span class="mw-page-title-main">Arterial dissections</span> Medical condition

An arterial dissection is a tear within the wall of an artery, which allows blood to separate the wall layers. There are several types. Usually, a tear is in an arterial wall, but a vein wall tear has been documented.

<span class="mw-page-title-main">Thyroid ima artery</span> Artery of the head and neck

The thyroid ima artery is an artery of the head and neck. It is an anatomical variant that, when present, supplies blood to the thyroid gland primarily, or the trachea, the parathyroid gland and the thymus gland in rare cases. It has also been reported to be a compensatory artery when one or both of the inferior thyroid arteries are absent, and in a few cases the only source of blood to the thyroid gland. Furthermore, it varies in origin, size, blood supply, and termination, and occurs in around 3.8% of the population and is 4.5 times more common in fetuses than in adults. Because of the variations and rarity, it may lead to surgical complications, particularly during tracheostomy and other airway managements.

Interrupted aortic arch is a very rare heart defect in which the aorta is not completely developed. There is a gap between the ascending and descending thoracic aorta. In a sense it is the complete form of a coarctation of the aorta. Almost all patients also have other cardiac anomalies, including a ventricular septal defect (VSD), aorto-pulmonary window, and truncus arteriosus. There are three types of interrupted aortic arch, with type B being the most common. Interrupted aortic arch is often associated with DiGeorge syndrome.

<span class="mw-page-title-main">Superior cardiac nerve</span>

The superior cardiac nerve arises by two or more branches from the superior cervical ganglion, and occasionally receives a filament from the trunk between the first and second cervical ganglia. It runs down the neck behind the common carotid artery, and in front of the Longus colli muscle; and crosses in front of the inferior thyroid artery, and recurrent nerve. The course of the nerves on the two sides then differs.

Double aortic arch is a relatively rare congenital cardiovascular malformation. DAA is an anomaly of the aortic arch in which two aortic arches form a complete vascular ring that can compress the trachea and/or esophagus. Most commonly there is a larger (dominant) right arch behind and a smaller (hypoplastic) left aortic arch in front of the trachea/esophagus. The two arches join to form the descending aorta which is usually on the left side. In some cases the end of the smaller left aortic arch closes and the vascular tissue becomes a fibrous cord. Although in these cases a complete ring of two patent aortic arches is not present, the term ‘vascular ring’ is the accepted generic term even in these anomalies.

<span class="mw-page-title-main">Tracheoinnominate fistula</span> Medical condition

Tracheoinnominate fistula is an abnormal connection (fistula) between the innominate artery and the trachea. A TIF is a rare but life-threatening iatrogenic injury, usually the sequela of a tracheotomy.

References

PD-icon.svgThis article incorporates text in the public domain from page 548 of the 20th edition of Gray's Anatomy (1918)

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