The subclavian arteries are vessels that carry blood to the upper extremities of the human body. In this article, all the basic concepts on this topic will be discussed in detail. You will learn what subclavian artery syndrome is and what features of its treatment exist.
What is the subclavian artery?
The circulatory system is a complex intricacies of various veins, arteries, capillaries. A large paired vessel that receives blood from the aortic arch - the subclavian artery - belongs to the vessels of the systemic circulation of a person. It supplies blood to the occipital regions of the brain, the cerebellum, the cervical part of the spinal cord, the muscles and parts of the organs of the neck, the shoulder girdle and upper limb, and some parts of the chest and abdomen.
Topography of the subclavian artery
What does the word "topography" itself mean? This is the literal location or location of something relative to some objects. Let us consider in more detail what the topography of the subclavian artery means, in other words,where and with respect to what it is located. It originates on one side of the brachiocephalic trunk, and on the other - from the aortic arch, bypasses the apex of the lung and exits through the opening of the chest from above. In the neck, the subclavian artery is visible next to the brachial plexus and is on the surface. This arrangement of the vessel allows it to be used to stop possible bleeding or to administer medications. Further, the subclavian artery bends over the rib, passes under the clavicle and enters the armpit, where it already becomes the axillary. Then, after passing the armpit, it goes to the shoulder. The name of this section is the brachial artery. In the region of the elbow joint, it diverges into the radial and ulnar arteries.
Catheterization of the subclavian vein. Puncture
As mentioned above, in the neck the subclavian vein (and artery too) lie on the surface. It is this place that is used to take a puncture, insert a catheter. What justified the choice of this particular part of the vessel? There are several criteria for this choice, these are:
- Anatomical accessibility.
- Position stability and lumen diameter.
- Sufficient or significant size (diameter).
- The speed of blood flow exceeds the speed of blood in the veins of the limbs.
Based on the data presented above, the catheter inserted into the vein will hardly touch the walls of the artery. Medicines that are injected through it will quickly reach the right atrium andventricle, they contribute to the active influence on hemodynamics. Drugs injected into the subclavian vein mix very quickly with the blood without irritating the inside of the artery. In some cases, there are contraindications for punctures and catheter insertion.
Left and right subclavian artery
This vessel is a paired organ, as mentioned above: the right subclavian artery and the left one. The first is the final branch of the brachiocephalic trunk, as for the left, it emerges from the aortic arch. In addition, the latter is about 4 cm longer than the former. The right subclavian artery supplies blood to some parts of the right arm, supplies it to the head and chest. The left subclavian artery carries fluid carrying life-sustaining substances to the left arm.
Main divisions of the subclavian artery
The left and right subclavian arteries are divided purely conditionally into three main departments, or sections:
- From the place of formation of the subclavian artery to the entrance to the interstitial space.
- Department, which is limited precisely to the interstitial space.
- At the exit from the interstitial space to the armpit.
Branches of the first division of the subclavian artery
This part of the article will tell you a little about what the subclavian artery and its branches look like, that is, what parts this vessel branches into. From its first section (the place between the entrance to the interstitial space and the beginning of the artery) several branches depart, here are the main ones:
- Vertebral artery, steam room. She goes throughtransverse process of the sixth cervical vertebra. Then it rises up and enters the cranial cavity through the back of the head, that is, through its opening. Then it connects with the same artery of the other side, thereby forming the basilar artery. What is the function of the vertebral artery? This vessel supplies blood to the spinal cord, hard occipital lobes of the brain, and muscles.
- The internal mammary artery begins at the bottom of the subclavian artery. The channel supplies blood to the thyroid gland, diaphragm, bronchi, sternum, etc.
- Thyroid trunk. It originates near the inner edge of the scalene muscle, reaches a length of about 1-2 cm. The thyroid trunk divides into branches that supply blood to the muscles of the scapula and neck, as well as the larynx.
Branches of the second and third divisions of the subclavian artery
The second section of the subclavian artery, limited by the interstitial space, has only one branch, it is called the costocervical trunk. It starts at the back of the subclavian artery and divides into several branches:
- The highest intercostal artery (posterior branches depart from this artery, leading blood to the muscles of the back).
- Spinal vessels.
- Deep cervical artery.
The third section of the subclavian artery also has one branch - this is the transverse artery of the neck. It permeates the shoulder meeting and is subdivided into:
- The superficial artery that supplies bloodback muscles.
- Dorsal artery of the scapula. It descends to the broad muscle of the back, nourishes it and the small muscles nearby.
- Deep branch of the subclavian artery.
Here, such concepts as the subclavian artery and its branches are described in sufficient detail, additional information can be gleaned from the medical literature.
Possible diseases of the subclavian artery
The main disease that affects the subclavian artery and its branches is the narrowing of the lumen of the vessels, in other words, stenosis. The main cause of this disease is atherosclerosis of the subclavian artery (deposition of lipids on the walls of blood vessels) or thrombosis. This disease is most often acquired, but there are cases of congenital. Risk factors for atherosclerosis of the subclavian artery are:
- Hypertension.
- Smoking.
- Overweight, obese.
- Diabetes and some other diseases.
The most common cause of subclavian artery stenosis is a metabolic disorder in the human body, neoplasms and inflammation. Severe stenosis leads to a decrease in blood flow to the vital organs of a person, there is a lack of oxygen and nutrients in the tissues. In addition, stenosis can cause coronary disease, in particular stroke.
Subclavian artery syndrome
Insufficient blood flow can be caused not only by obstruction of blood flow due to occlusive-stenotic lesions, but also by spinal-subclavian"robbing". This syndrome of the subclavian artery, or steel syndrome, develops in the event of a stenosis or occlusion in the first section of this vessel. Simply put, blood in the subclavian canal does not come from the aorta, but from the vertebral artery, which can lead to cerebral ischemia. The maximum manifestations of this disease cause physical stress on the upper limb.
Symptoms of disease:
- Dizziness.
- Pre-syncope.
- Deterioration of vision.
- Muscle weakness on affected side.
- Weakening or complete absence of a pulse on the affected side.
Learn more about subclavian artery stenosis
Deposits on the walls of blood vessels, leading to narrowing of the latter, have a lipid base, that is, in fact, they are derivatives of cholesterol. These deposits can narrow the lumen of the vessel up to 80%, sometimes even completely clog it. In addition to the above factors that cause stenosis of the subclavian artery, there are others, such as:
- Irradiation.
- Arteritis.
- Compression syndromes.
- Various lesions such as fibromuscular dysplasia etc.
Very often in people suffering from stenosis of the subclavian artery, other vessels are also affected. These can be both coronary canals, that is, cardiac, and carotid, arteries of the lower extremities. Basically, with such a pathology as narrowing of the lumen of the vessels, the left subclavian artery is affected. Statistically, this happens several times more often thanfrom the right.
Stenosis symptoms:
- Weakness in muscles.
- Feeling tired.
- Pain in upper limbs.
- Necrosis of fingers.
- Bleeding around nails.
In addition, neurological symptoms may appear, that is, “stealing” occurs: blood is redirected from normal vessels to the affected area. Symptoms of neurological disease:
- Impaired vision.
- Loss of consciousness.
- Speech impairment.
- Lost balance.
- Dizziness.
- Loss of sensation in the face.
How to treat subclavian artery stenosis?
Treatment for stenosis can be medical, surgical or interventional. The main methods of therapy are X-ray endovascular stenting of the subclavian artery and carotid-subclavian bypass. The latter method is recommended for people with a hypersthenic physique, in whom it is rather difficult to isolate the first section of the artery. Also, this method of treatment is recommended for stenosis in the second subclavian artery.
Stenting of the subclavian artery
Stenting is the treatment of the subclavian artery through a small incision in the skin, 2-3 mm long, it is done through a puncture hole. This method of therapy has a number of advantages over surgery, as it causes less trauma and discomfort. In addition, this is the most sparing and organ-preserving method of treatment, in whichthe subclavian artery is preserved in its original form, which is very important for the patient.
The stenting procedure is virtually painless and takes place under local anesthesia. This operation allows you to increase the lumen of blood vessels using special catheters and stents in the form of balloons. The latter is a cylindrical endoprosthesis laser cut from a solid metal tube. This device is attached to a special balloon catheter and moves in a compressed state in the subclavian artery. When the stent reaches the narrowing of the vessel, some control procedures are performed related to its correct location. After that, the device opens under high pressure. If the stent is not sufficiently opened, then angioplasty of the stented area is performed with a special catheter with a balloon at the end for optimal results. To date, it is possible to perform this operation for free, it can be done by obtaining a federal quota. A patient with a similar disease must be consulted by the attending physician.
Possible risks of stenting
The subclavian artery stenting procedure takes about 2 hours. This operation is performed in the cardiac catheterization department. After stenting, pain medications are taken if necessary, since pain may occur in the place where the subclavian artery and tissues were incised. Complications after this procedure are very rare, as the patient before itis carefully trained and monitored. But still, some unpleasant consequences can arise, these are:
- Allergy to medications taken.
- Reaction to anesthetics.
- Small bleeding at the incision site.
- Temperature.
- Headache.
- Infection.
- Air embolism.
- Injury to the wall of an artery or aorta.
- Thrombosis of the subclavian artery.
- Stent migration.
- Neurological complications, etc.
Interventional treatment of subclavian artery stenosis by balloon angioplasty and stenting are modern minimally invasive and effective methods of therapy. They have very short postoperative periods and hospitalizations.
