Vascular: Thoracic Vasculature

Thoracic Arterial Supply

Aortic Arch

  • Branches: Mn
    • Innominate/Brachiocephalic Artery
      • Right Subclavian
      • Right Common Carotid
    • Left Common Carotid
    • Left Subclavian
  • “Bovine Arch”
    • Normal Variant
    • Common Origin of Innominate & Left Common Carotid

Descending Thoracic Aorta Branches

  • Bronchial Branches
  • Esophageal Branches
  • Posterior Intercostal Arteries
  • Becomes the Abdominal Aorta After the Diaphragm

Aortic Arch 1

Thoracic Aorta 1

Subclavian Artery

  • Parts:
    • First Part: Proximal to the Anterior Scalene
    • Second Part: Behind the Anterior Scalene
    • Third Part: Distal to Anterior Scalene
  • Branches: Mn
    • First Part:
      • Vertebral Artery
      • Internal Thoracic Artery (Internal Mammary Artery)
        • Anterior Intercostal Arteries
        • Becomes the Superior Epigastric Artery
      • Thyrocervical Trunk
        • Inferior Thyroid Artery
        • Suprascapular Artery
        • Transverse Cervical Artery
    • Second Part:
      • Costocervical Trunk
        • Superior Intercostal Artery
        • Deep Cervical Artery
    • Third Part:
      • Dorsal Scapular Artery
  • Termination: Becomes the Axillary Artery After the First Rib

Subclavian Artery 2

Thyrocervical Trunk 1

Subclavian Artery Branches 3

Axillary Artery

  • From the Subclavian Artery (Transitions at the First Rib)
  • Becomes the Brachial Artery (Transitions at the Teres Major)
  • Parts:
    • First Part: Superior to Pectoralis Minor
    • Second Part: Posterior to Pectoralis Minor
    • Third Part: Inferior to Pectoralis Minor
  • Branches: Mn
    • First Part:
      • Superior Thoracic Artery
    • Second Part:
      • Thoracoacromial Artery
      • Lateral Thoracic Artery
    • Third Part:
      • Subscapular Artery
      • Anterior Humeral Circumflex Artery
      • Posterior Humeral Circumflex Artery

Axillary Artery Branches 1

Thoracic Venous Drainage

Drainage into the Right Atrium

Brachiocephalic (Innominate) Vein Sources

  • Internal Jugular Vein
  • Subclavian Vein
    • External Jugular Vein
    • Axillary Vein
      • Basilic Vein
      • Cephalic Vein
  • Vertebral Vein
  • Inferior Thyroid Vein

Azygos System

  • Azygos Vein
    • Along Right Vertebral Column
    • Drains Into: SVC
  • Hemiazygos Vein
    • Along Left Lower Vertebral Column
    • Drains Into: Azygos Vein
  • Accessory Hemiazygos Vein
    • Along Left Upper Vertebral Column
    • Drains Into: Azygos Vein

Innominate Vein Sources 1

Azygos System 3

Thoracic Outlet

Superior Thoracic Outlet Boundaries

  • Anterior: Sternum
  • Lateral: First Rib
  • Posterior: Vertebrae

Order of Structures (Anterior to Posterior) Mn

  • Clavicle
    • Subclavian Vein
    • Phrenic Nerve
  • Anterior Scalene
    • Subclavian Artery
    • Brachial Plexus
  • Middle Scalene

Thoracic Outlet Structures 4

Thoracic Outlet – Posterior Half 5

Mnemonics

Branches of the Aorta

  • Aortic Branches: “ABC’S”
  • Aorta-Brachiocephalic-Carotid-Subclavian

Branches of the Subclavian Artery

  • Subclavian Branches: “VITamin C & D”
  • First Part – VIT
    • Vertebral Artery
    • Internal Thoracic Artery (Internal Mammary Artery)
    • Thyrocervical Trunk
  • Second Part – C
    • Costocervical Trunk
  • Third Part – D
    • Dorsal Scapular Artery

Branches of the Axillary Artery

  • “Screw The Lawyer, Save A Patient” or “She Tastes Like Sweet Apple Pie”
  • First Part:
    • Superior Thoracic Artery
  • Second Part:
    • Thoracoacromial Artery
    • Lateral Thoracic Artery
  • Third Part:
    • Subscapular Artery
    • Anterior Humeral Circumflex Artery
    • Posterior Humeral Circumflex Artery

Structure of the Thoracic Outlet

  • *After Clavicle (x2): Vessel > Nerve > Muscle
  • *Subclavian Vein is First (Think About Placing a Subclavian Central Line)

References

  1. Gray H. Anatomy of the Human Body (1918). Public Domain.
  2. Wikimedia Commons. (License: Public Domain)
  3. Sobotta J. Wikimedia Commons. (License: Public Domain)
  4. Zeorsky N. Wikimedia Commons. (License: CC BY-SA-3.0)
  5. Khan A, Rattihalli RR, Hussain N, Sridhar A. Bilateral thoracic outlet syndrome: An uncommon presentation of a rare condition in children. Ann Indian Acad Neurol. 2012 Oct;15(4):323-5. (License: CC BY-NC-SA-3.0)