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Duke Orthopaedics
presents
Wheeless' Textbook of Orthopaedics

Subclavian Artery



- See:
      - arteries of the upper limb
      - subclavian vein
      - thoracic outlet syndrome;

- Discussion:
    - injuries are rare because of overlying bony skeleton;
    - right subclavian artery originates from innominate artery & passes into neck behind the right SC joint;
    - left subclavian artery comes off aortic arch and enters neck behind left sternoclavicular joint;
    - as it traverses the base of the neck, it lies between the anterior scalene and the scalene medius muscle;
    - subclavian artery is divided into three parts by its relation to scalenus anticus muscle;
    - at lateral border of first rib the subclavian artery continues as axillary artery;
    - frxs of first rib or clavicle may cause injury to subclavian vessel, but this is rare;
    - assoc neurological injuries frequently cause permanent disability;
    - when neurologic deficit is caused by compression of brachial plexus by hematoma rather than by direct injury, early evacuation of hematoma may result in significant functional improvement;
    - there are a few small series of patients with subclavian injuries w/ neurologic deficits:
    - prompt exploratory surgery even in absence of distal ischemia, w/ goal of relieving compression on brachial plexus by hematoma;
            - pts will improve if there is not direct injury to brachial plexus;
    - ligation of the subclavian artery is usually well tolerated because of execellent collateral circulation around the shoulder girdle;

- Subclavian Artery Aneurysms:
    - usually do to atherosclerosis, but may be due to trauma;
    - if thrombosis is present, there may be emboli to hands;
    - these may be either intrathoracic or supraclavicular (pulsating mass)
    - usually is seen on the right side;
    - most of these aneurysms contain mural thrombi



An Experience with Upper-Extremity Vascular Trauma.

Year Book: Management of Arm Arterial Injuries.

Evaluation of patients with thoracic outlet syndrome.

Arterial abnormalities of the shoulder in athletes.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, April 11, 2012 12:12 pm