Left subclavian artery. Subclavian artery. Division into departments

Passes in interstitial space, where lies in the same-named groove of the first rib. Coming out of the interstitial space, the artery at the outer edge of the first rib continues into the axillary artery, the latter passes into the brachial artery.

The subclavian artery has three divisions:

• the first - from the place of its beginning to the entrance to the interstitial space
• second - in the interstitial space
• third - from the interstitial space to the entrance to the axillary cavity

There are four segments of the vertebral artery:

• prevertebral (V1)- from the subclavian artery to the entrance to the transverse foramen of the VI cervical vertebra
• cervical (V2)- in the transverse foramens of the VI-II cervical vertebrae
• atlantic (V3)- in the transverse foramen and the eponymous groove of the I cervical vertebra
• intracranial (V4)- in the cranial cavity

On the neck from the vertebral artery depart spinal branches (rr. spinales), which penetrate the spinal canal through the intervertebral foramina. In the cranial cavity, the following branches off the vertebral artery:

• anterior spinal artery (a. spinalis anterior) - right and left, are connected into one trunk, which descends along the anterior median fissure of the medulla oblongata and spinal cord
• posterior spinal artery (a. spinalis posterior), steam room, descends along the posterior surface of the medulla oblongata and spinal cord; the spinal arteries, going along the spinal cord, anastomose with the spinal branches of the vertebral, intercostal and lumbar arteries.
• posterior inferior cerebellar artery (a. cerebelli inferior posterior) - branches on the lower surface of the cerebellar hemisphere.

Internal mammary artery

Internal mammary artery(a. thoracica interna) - departs from the lower surface of the subclavian artery. It supplies blood to the thyroid gland, the connective tissue of the upper and lower anterior mediastinum, the main bronchi, small branches go to the pericardium, parietal pleura, blood supply to the sternum, diaphragm, intercostal and pectoral muscles, the rectus abdominis muscle and the skin of this area. Goes in the upper and lower mediastinum. Upper: behind the sternoclavicular joint. In the lower: behind the cartilages of the first-seventh ribs, 2 cm laterally, and from the lateral edge of the sternum, under the intrathoracic fascia. Below the cartilage of the seventh rib, it branches into muscular-diaphragmatic and superior epigastric artery. The latter will anastomose with lower epigastric artery (a. epigastrica inferior) external iliac artery (a. iliaca externa).

Also departing from it:

• pericardial phrenic artery (a. pericardiacophrenica)
• superior epigastric artery- enters the vagina of the rectus abdominis muscle and, as mentioned earlier, anastomoses with lower epigastric artery (a. epigastrica inferior) pertaining to the pool external iliac artery (a. iliaca externa).
• musculophrenic artery- goes behind the costal arch and gives off the anterior intercostal branches to the fifth intercostal space
• perforating branches (rr. perforantes)- women depart from them medial branches of the chest(rr. mammarii mediales)
• tracheal branches (rr. tracheales)
• branches of the thymus (rr. thymici)
• bronchial branches (rr. bronchiales)
• sternal branches (rr. sternales)
• anterior intercostal branches (rr. intercostales anteriores)- depart two in each of the five upper intercostal spaces
• mediastinal branches (rr. mediastenalii).

Thyroid trunk

Thyroid trunk ( truncus thyrocervicalis) - located at the inner edge of the anterior stair layer, rather short.

Departing from it:

• inferior thyroid artery ( a. thyroidea inferior), which with its branches supplies blood to the thyroid gland, pharynx, upper esophagus, trachea, larynx
• ascending cervical artery ( a. cervicalis ascendens) - rises up the scalene muscles, supplies blood to the deep muscles of the neck and spinal cord
• superficial cervical artery ( a. cervicalis superficialis), supplies blood to the skin of the lateral surface of the neck
• suprascapular artery ( a. suprascapularis) - goes through shoulder blade (incissura scapulae) in supraspinatus and infraspinatus fossa, where it supplies the muscles of the same name and anastomoses with the scapular artery of the same name.

Second department

In the second section, only one branch departs from the subclavian artery - costocervical trunk (truncus costocervicalis) . It is also a short structure, which almost immediately crumbles into its final branches.

Branches of the costo-cervical trunk:

• deep cervical artery(a. cervicalis profunda) goes back and slightly upward, passes under the neck of the 1st rib, goes into the neck and follows up to the 2nd cervical vertebra, supplying blood to the deep muscles of the back of the neck, and also sending branches to the spinal cord in the spinal canal. Its branches anastomose with branches from a. vertebralis, a. cervicalis ascendens and from a. occipitalis.
• superior intercostal artery(a. intercostalis suprema) goes down, crosses the anterior surface of the neck of the 1st rib, and then the 2nd rib and sends it to the first and second intercostal spaces posterior intercostal arteries(I and II). (aa. intercostalis posterioris I et II). The latter, following in the intercostal spaces, are connected to anterior intercostal branches a. thoracica interna.

From superior intercostal artery depart:

a) spinal branches ( rr. spinalis)

b) back branches ( rr. dorsales) to the muscles of the back.

Third department

In the third section of the subclavian artery, one artery can depart - transverse artery of the neck(a.transversum cervicales), but if it is not here, then it will depart directly from the thyroid trunk. But we will argue from the most common version of the norm. transverse artery of the neck departs from the subclavian artery at the lateral edge of the scalene muscle. It pierces the brachial plexus, dividing into the superficial one, which supplies blood to the muscles of the back, and the dorsal artery of the scapula, which descends along the medial edge of the scapula to the muscles of the back.

On the girdle of the upper limb, the subclavian artery continues into the axillary artery at the level of the lower edge of the 1st rib.

Histology of the subclavian artery

The subclavian artery is an artery muscular-elastic type. Its walls are built of three shells:

• internal- Made up of the endothelium and subendothelial layer. The endothelium is formed by a layer of flat, polygonal, elongated cells with uneven wavy edges that lie on the basement membrane. The subendothelial layer is formed by loose irregular connective tissue, which contains thin elastic and collagen fibers.
• average- consists of smooth muscle cells and elastic fibers, the ratio of which in the middle shell is approximately 1:1. This shell contains a small amount of fibroblasts and collagen fibers.
• external- formed by loose fibrous connective tissue containing bundles of smooth myocytes, elastic and collagen fibers. It contains vascular vessels (vasa vasorum) that provide trophic function.

Sources and literature

• Atlas of human anatomy Sinelnikova R.D. etc. Volume 3 ISBN 978-5-7864-0201-9
• Histology with the basics of histological technique / Edited by V.P. Peshka. Textbook. - Kyiv: CONDOR, 2008. - 400 p. ISBN 978-966-351-128-3
• Human Anatomy: In 2 vols. - K.: Zdorovye, 2005. - Vol. 2. - 372 p. ISBN 5-311-01342-7

Subclavian artery, a. subclavia. Branches of the first division of the subclavian artery.

Only left subclavian artery, a. subclavia, refers to the number of branches extending directly from the aortic arch, while the right one is a branch of the truncus brachiocephalicus.

The artery forms a convex upward arc, envelope of the dome of the pleura. It leaves the chest cavity through the apertura superior, approaches the collarbone, lies down in sulcus a. subclaviae I rib and bends over it. Here the subclavian artery can be pressed to stop the bleeding to the 1st rib behind tuberculum m. scaleni. Further, the artery continues into the axillary fossa, where, starting from the outer edge of the 1st rib, it receives the name a. axillaris. On its way, the subclavian artery passes along with the brachial plexus through the spatium interscalenum, therefore it has 3 divisions: the first- from the starting point to the entrance to the spatium interscalenum, second- in spatium interscalenum and third- upon exiting it, before moving to a. axillaris.

Branches of the first section of the subclavian artery (before entering the spatium interscalenum):

1. A. vertebralis, vertebral artery, the first branch extending upward in the interval between m. scalenus anterior and m. longus colli, goes to the foramen processus transversus of the VI cervical vertebra and rises up through the holes in the transverse processes of the cervical vertebrae to the membrana atlantooccipitalis posterior, perforating which it enters through the foramen magnum of the occipital bone into the cranial cavity. In the cranial cavity, the vertebral arteries of both sides converge to the midline and near the posterior edge of the bridge merge into one unpaired basilar artery, a. basilaris.
On its way, it gives off small branches to the muscles, spinal cord and hard shell of the occipital lobes of the brain, as well as large branches:
a) a. spinalis anterior leaves in the cranial cavity near the confluence of two vertebral arteries and goes down and towards the midline towards the same-named artery of the opposite side, with which it merges into one trunk;
b) a. spinalis posterior departs from the vertebral artery immediately after its entry into the cranial cavity and also goes down the sides of the spinal cord. As a result, three arterial trunks descend along the spinal cord: unpaired - along the anterior surface (a. spinalis anterior) and two paired - along the posterolateral surface, one on each side (aa. spinales posteriores). All the way to the lower end of the spinal cord, they receive reinforcements in the form of rr through the intervertebral foramina. spinales: in the neck - from aa. vertebrales, in the thoracic region - from aa. intercostales posteriores, in the lumbar - from aa. lumbales.
Through these branches, anastomoses of the vertebral artery with the subclavian artery and the descending aorta are established;
c) a. Cerebelli inferior posterior- largest branch a. vertebralis, begins near the bridge, goes back and, bypassing the medulla oblongata, branches on the lower surface of the cerebellum.

A. basilaris, basilar artery, obtained from the fusion of both vertebrates, unpaired, lies in the median groove of the bridge, at the front edge it is divided into two aa. cerebri posteriores (one on each side), which go back and up, go around the lateral surface of the legs of the brain and branch out on the lower, inner and outer surfaces of the occipital lobe.
Taking into account the aa described above. communicantes posteriores from a. carotis interna, the posterior cerebral arteries are involved in the formation of the arterial circle of the brain, circulus arteriosus cerebri. From trunk a. basilaris small branches depart to the bridge, to the inner ear, passing through the meatus acusticus internus, and two branches to the cerebellum: a. cerebelli inferior anterior and a. cerebelli superior.

A.vertebralis, running parallel to the trunk of the common carotid artery and participating along with it in the blood supply to the brain, is a collateral vessel for the head and neck.
Merged into one trunk, a. basilaris, two vertebral arteries and two aa merged into one trunk. spinales anteriores, form arterial ring, which, along with circulus arteriosus cerebri - Circle of Willis arterial is important for the collateral circulation of the medulla oblongata.

2. Truncus thyrocervicalis, thyroid trunk, moving away from a. subclavia up at the medial edge m. scalenus anterior, is about 4 cm long and is divided to the following branches:
a) a. thyroidea inferior goes to the posterior surface of the thyroid gland, gives a. laryngea inferior, which branches in the muscles and mucous membrane of the larynx and anastomoses with a. laryngea superior; branches to the trachea, esophagus and thyroid gland; the latter anastomose with branches a. thyroidea superior from system a. carotis externa;
b) a. cervicalis ascendens goes up m. scalenus anterior and supplies the deep muscles of the neck;
in) a. suprascapularis goes from the trunk down and laterally, to the incusura scapulae, and, bending over the lig. transversum scapulae, branches in the dorsal muscles of the scapula; anastomoses with a. circumflexa scapulae.

3. A. thoracica interna, internal thoracic artery, departs from a. subclavia against start a. vertebralis, goes down and medially, adjacent to the pleura; starting from the I costal cartilage, goes vertically down at a distance of about 12 mm from the edge of the sternum.
Having reached the lower edge of the VII costal cartilage, a. thoracica interna is divided into two terminal branches: a. musculophrenica stretches laterally along the line of attachment of the diaphragm, giving branches to it and into the nearest intercostal spaces, and a. epigastric superior- keeps going a. thoracica interna downwards, penetrates into the vagina of the rectus abdominis muscle and, having reached the level of the navel, anastomoses with a. epigastica inferior (from a. iliaca externa).
On his way a. thoracica interna gives branches to the nearest anatomical formations: the connective tissue of the anterior mediastinum, the thymus gland, the lower end of the trachea and bronchi, to the six upper intercostal spaces and the mammary gland. Her long branch a. pericardiacophrenica, together with n. phrenicus goes to the diaphragm, giving branches to the pleura and pericardium along the way. Her rami intercostales anteriores go in the upper six intercostal spaces and anastomose with aa. intercostales posteriores(from the aorta).

The human circulatory system is a complex scheme of intricately woven veins, arteries and many capillaries. The subclavian artery is a paired and very large vessel, belongs to the arteries of the great circle. It receives blood from the aortic arch and the brachiocephalic trunk and supplies nutrients to the back of the head, part of the spinal cord located in the cervical region, and the cerebellum. Also, the blood from this vessel supplies oxygen to the upper limbs, shoulder girdle and some parts of the peritoneum and chest.

Anatomy

This artery is a convex vessel in the form of an arc located in the anterior mediastinum. Heading up the chest laterally, the vessel goes around the pleura and is superimposed on the upper part of the lung. The topography of the subclavian artery, relative to the neck area, contributes to the supply of oxygen to the neck muscles and the occipital part of the head.

The vessel is located on the surface and is visible next to the brachial plexus of nerves. The anatomy of the subclavian artery makes it possible to use it for the administration of medications, and also, with heavy bleeding, there is an excellent chance to prevent unpleasant consequences.

Departing from the brachial plexus, the vessel bends over the rib. Here a groove of the subclavian artery is formed, which extends under the clavicle and rises into the armpit. In this area, the vessel passes into the axillary artery. Having passed the armpit, the artery enters the shoulder and becomes the brachial. In the region of the elbow joint, the subclavian artery diverges into the ulnar and radial arteries.

Main branches

The left subclavian artery, like the right one, is very large and is part of the systemic circulation. On its way through the body, it gives off several branches through which blood passes to supply oxygen and nutrients to internal organs, skin integuments in various parts of the body.

At certain points, this vessel diverges into five branches.

Internal mammary artery

This vessel departs in the region of the pleural dome from the main artery. It passes between the intrathoracic fascia and the pleura, heading towards the lower part of the sternum.

In turn, the thoracic internal artery is divided into:

1. mediastinal branch;
2. Tracheal;
3. perforating;
4. thymus;
5. bronchial;
6. Anterior intercostal;
7. Pericardiodiaphragmatic;
8. Upper epigastric;
9. Muscular-diaphragmatic.

vertebral artery

This vessel originates a few millimeters medial to the anterior edge of the scalene muscle, in the interscalene space. The anterior part of the artery is covered by the inferior supraclavicular thyroid vessel and the carotid artery.

This branch from the subclavian artery is one of the largest and discards the following branches:

1. Posterior inferior cerebellar;
2. villous;
3. Posterior, anterior spinal;
4. Meningeal.

thyroid trunk

This vessel has a length of 0.5-1.5 cm. It branches off from the subclavian artery in the region of the anterior scalene muscle.

As well as other branches, it is divided into several arteries extending from it:

1. Ascending cervical;
2. Superficial cervical;
3. lower thyroid;
4. Suprascapular.

Costo-cervical trunk

This large vessel departs from the wall of the subclavian artery to the small axillary vessel in the interstitial space and is located at the first rib, at its head.

The trunk in its course is divided into the following branches of the large subclavian artery:

1. cervical transverse;
2. Intercostal overhanging;
3. Neck deep;
4. Surface.

Basilar artery

This vessel is formed as a result of the connection of two vertebral arteries in the region of the posterior edge of the bridge.

The following branches of the blood channels depart from it:

1. Posterior cerebral;
2. Artery of the labyrinth;
3. Superior cerebellar;
4. pontine artery;
5. Inferior anterior cerebellar;
6. Mid-brain.

Departments and functions

The superficial location of this vessel is very convenient for puncture. Subclavian artery catheterization is also often performed in this area of ​​the neck. Specialists prefer this site, because it is accessible, due to its anatomical features, the artery has a more than suitable lumen diameter, a stable position.

During catheterization, the delivered catheter will not come into contact with the walls of the vessel, and the drug that will be injected through it will quickly reach the goal, actively influencing hemodynamics.

The main divisions of the subclavian artery are three sections:

• Interstitial space. The vertebral and steam arteries depart from it;
• Costo-cervical trunk;
• Branching of the transverse cervical artery.

The subclavian vessel, located in the 1st section, passes into the skull. Its function is to supply blood to the brain, neck muscles. The internal thoracic artery supplies blood to the thyroid gland, diaphragm, and bronchi. It is divided into an overhanging intercostal vessel and other adjacent arteries.

Palpation

Probing and examination of the subclavian artery (palpation) is carried out according to the apical impulse palpation scheme, that is, with three or two fingers. First, the arteries are examined at the edge of the sternocleidomastoid muscles above the collarbones. Then a transition is made to the region of the depth of the subclavian fossae under the collarbones at the edges of her deltoid muscles. The study is carried out very carefully, by applying fingers and pressing on the soft tissues in the area of ​​​​the externally examined area.

In a healthy person who is at rest, the subclavian arteries will not be palpated, or their pulsation will be barely perceptible. This is due to their sufficient depth of occurrence. You can feel a strong pulsation in people with poor development of the muscle tissue of the shoulder and neck, after physical exertion, emotional upheaval, as well as in asthenic patients.

With the pathology of the subclavian artery, its pulsation is clearly manifested. This phenomenon can be observed in aortic insufficiency and hyperkinetic type of hemodynamics. With an aneurysm of the vessels, a pulsation is usually palpated in the supraclavicular area, slightly limited (2-3 cm). The weakening of the pulsation of these arteries can be accurately assessed by probing them simultaneously using both hands. This may be due to a violation of their patency (thrombosis, compression, atheromatosis) or, if there is an anomaly, an aberrant right subclavian artery.

Possible pathologies

The most common disease that affects the subclavian artery and its branches is stenosis. This pathology develops due to the presence of atherosclerosis or thrombosis. The disease can be both congenital and acquired. People who are fond of smoking, overweight and suffering from diabetes are at risk of getting stenosis.

Also, quite often, stenosis develops against the background of impaired metabolism, due to neoplasms and a long-term inflammatory process. In the first course of the disease in an acute form, a significant decrease in blood flow is possible, which can cause a stroke or ischemia. With stenosis of the subclavian arteries, the majority of patients complain of severe pain, which increases with exertion.

Treatment Method

A disease such as stenosis can be treated with medication, in its mild form, interventionally and surgically. But the main methods of therapy, according to experts, are shunting and stenting. These treatments have been used for a very long time and have an excellent success rate for the procedure.

shunting

If stenosis is detected in the 2nd section of the artery, shunting is indicated. If the ipsilateral common carotid artery is damaged, a crossover bypass is preferred. This method of surgical intervention does not injure the tissues and organs of the patient, does not require the use of general anesthesia, takes a little time and does not cause serious postoperative complications. Before it is carried out, it is necessary to conduct an ultrasound scan.

If the subclavian large artery is damaged on the left or on both sides, then its reconstruction in the affected area will first be necessary. If the operation is unsuccessful, re-intervention is difficult. Contralateral lesions of the subclavian vessels require preliminary elimination of the steel syndrome, only then can shunting be started. Reconstruction of the damaged section of the artery is possible only with non-regressive vertebrobasilar insufficiency. All surgical interventions, be it shunting, stenting, and others, are not carried out without a complete preliminary examination of the patient and an accurate diagnosis.

Stenting

This method is indicated for patients who have a hypersthenic physique and a special topography of their subclavian arteries. The first section of the artery in such people is difficult to grope. The method of stenting is very convenient and significantly prevails over surgical abdominal intervention. With this gentle process, there is no change in the arteries, and the tissues of the body are not injured.

With the help of stenting, doctors increase the lumen of the affected vessel. For this, a catheter and a balloon-shaped stent are used. All procedures are performed under local anesthesia. The movement of the stent along the artery occurs under the control of an experienced specialist, who regulates its location. Having reached the site of narrowing, the device opens. If the stent is not open enough, angioplasty is performed. The total operation time is no more than 2 hours.

Complications

Although such operations cannot be called complex, they still have a rather long rehabilitation period. After stenting, it is recommended to take painkillers, since the places of punctures and incisions in soft tissues and arteries can hurt. Postoperative complications are extremely rare, since before the procedure the patient undergoes a complete examination of the whole body (ultrasound, etc.). But still, the reaction of the body under certain circumstances can be unpredictable (for example, if there is a defect - an aberrant subclavian artery).

After stenting, the patient may experience:

• Allergy to drugs;
• Temperature rise;
• Headache;
• wound infection;
• Air embolism;
• Stent migration;
• Bleeding at the puncture site;
• arterial thrombosis;
• neurological complications.

Interventional therapy of stenosis and other diseases of the subclavian arteries by stenting and agioplasty is a modern minimally invasive measure. Such effective procedures are carried out in a very short time and do not require long-term hospitalization. It is enough to pre-pass an ultrasound and pass the necessary tests.

The subclavian artery is a paired vessel, which consists of the right and left branches, which has branches. Together with other vessels, it forms a systemic circle of blood circulation, comes from the anterior mediastinum. It transports oxygen, nutrients to the neck, upper limbs and other organs of the upper body. When an artery is damaged, blood flow is disturbed, which leads to various dangerous diseases. It is important to identify the pathology in time and treat it, otherwise the probability of death of the patient increases.

Location of the subclavian artery

The topography of this vessel is not as complicated as it might seem at first glance. The right artery is the terminal branch of the brachiocephalic trunk (common and external carotid arteries), and the left artery departs from the bend of the aorta. The left subclavian artery is longer than the right one (about 2.5 cm), and its intrathoracic section is located behind the brachiocephalic vein. The subclavian vein is located anterior and inferior to the arterial vessel of the same name.

The subclavian artery is divided into 3 divisions

The artery is located in a small space bounded by the clavicle and the right rib. In appearance, this is a convex arc that goes around the top of the lung and the upper part of the pleural sac. Having reached the I rib, the vessel passes between the middle and anterior scalene muscle, where the brachial plexus is located. Bypassing the rib, she goes under the collarbone, getting into the axillary space.

Anatomy of the subclavian vessel, depending on its departments.

Branches of the first department:

• The vertebral (vertebral) artery passes through the transverse process of the VI cervical vertebra, rises and enters the cranium through the opening between the skull and the spine. It then joins with the vessel on the other side, forming the basilar vessel. The vertebral artery supplies blood to the spinal cord, muscles, and occipital lobes of the brain.
• The thoracic internal artery emerges from the lower surface of the subclavian vessel. It saturates the thyroid gland, bronchi, diaphragm and other organs of the upper body with blood.
• The thyroid trunk comes from the scalene muscle, its length reaches no more than 1.5 cm and is divided into several branches. This branch saturates the inner membrane of the larynx, the muscles of the neck, and the shoulder blades with oxygen.

The second section has only the costocervical trunk, which emerges from the posterior surface of the subclavian vessel.

The third section is a transverse cervical arterial vessel that permeates the brachial plexus. It saturates the muscles of the scapula and neck with blood.

Aberrant subclavian artery is a common pathology of the aortic arch, which is characterized by a deviation from the normal structure of the vessel. In this case, the right vessel branches off from the arch and passes through the posterior mediastinum to the right.

Its location depending on the esophagus:

• 80% behind the esophagus;
• 15% - between the esophagus and trachea;
• 5% - in front of the trachea.

And the left arterial vessel goes to the right of the arch behind the esophagus, creating an incomplete vascular ring with the left arch.

Narrowing of an arterial vessel

This is a common pathology in which the artery located next to the subclavian vein is affected. In most cases, its narrowing is provoked by atherosclerosis and thrombosis. In this case, the first disease, which is characterized by the deposition of low-density cholesterol on the walls of blood vessels, can be congenital or acquired.

Stenosis is the narrowing of an artery

Damage to the artery under the clavicle occurs for the following reasons:

• the patient has hypertension;
• a person smokes, drinks alcohol;
• the patient is overweight;
• suffers from diabetes.

In addition, stenosis is a consequence of metabolic disorders, inflammatory reactions or oncological formations.

Other factors in the development of stenosis:

• exposure;
• arterial compression and other compressive neuropathies;
• inflammation of the arteries;
• fibromuscular dysplasia, etc.

In some cases, the narrowing of the vessel reaches 80%, and this threatens with obstruction of the artery. As a result, the likelihood of ischemia and stroke increases due to a lack of oxygen and nutrients.

Typical symptoms of stenosis:

• muscle weakness;
• increased fatigue;
• pain in the hands;
• hemorrhage in the area of ​​the nail plate;
• necrosis of the soft tissues of the fingers.

In addition, the pathology is manifested by severe neurological disorders:

• visual disturbances;
• speech disorders;
• violation of coordination in space:
• loss of consciousness;
• vertigo (dizziness);
• facial numbness.

If such symptoms occur, you should immediately consult a doctor to clarify the diagnosis and choose a method of treatment.

Pathology treatment methods

To assess the condition of the artery under the clavicle and establish an accurate diagnosis, instrumental and laboratory research methods are used:

• Triplex scanning using contrast compounds.
• Arteriography is a study during which an arterial vessel is pierced, a contrast agent is injected into it through a catheter. In exactly the same way, a puncture of the subclavian vein is performed during the diagnosis.
• MRI, CT, etc.

Surgical treatment of stenosis is considered the most effective.

There are 3 ways to treat stenosis: conservative, interventional, surgical. However, surgery is the most effective method of therapy. X-ray endovascular stenting is a surgical intervention that is performed using local anesthesia. During the procedure, the surgeon makes a miniature incision (about 3 cm) with a puncture to reduce the chance of injury and patient discomfort. The technique of the operation allows you to save the original appearance of the vessel, which is important.

This surgical method allows you to expand the artery using catheters and stents that look like balloons.

A stent is an endoprosthesis that is cut out of a metal tube. The device in a compressed state is fixed on a balloon catheter and injected into the vessel. The stent is then inflated under pressure.

Carotid-subclavian shunting is prescribed for patients with below average height and a tendency to be overweight. This is because it is difficult for the doctor to determine the first section of the artery under the clavicle. Also, this operation is recommended for patients with stenosis of the second part of the arterial vessel under the clavicle.

After the procedure, the following complications may occur:

• Injury to peripheral nerves.
• Plexopathy (inflammation of the nerve plexus).
• Dysphagia (difficulty swallowing).
• Puffiness.
• Horner's syndrome (damage to the sympathetic nerves).
• Stroke.
• Hemorrhages, etc.

The further condition of the patient depends on the general condition and the course of the operation.

Causes and signs of blockage

Occlusion is a pathology characterized by complete blockage of the lumen of the artery by cholesterol plaques. The disease occurs for the following reasons:

• Atherosclerosis (accumulation of cholesterol plaques on the walls of the vessel).
• Nonspecific aortoarteritis is a rare disease in which the aorta becomes inflamed and narrows, as well as its large branches (including the subclavian artery).
• Endarteritis is a chronic inflammation of the arteries, due to which blood flow is disturbed and gangrene develops.
• Tumors, cysts of the mediastinum.
• Vessel lumen occlusion after trauma or embolization (minimally invasive intravascular procedure).
• Complications after surgery on the subclavian artery.
• Congenital anomalies of the arch and branches of the aorta.

With occlusion, the lumen of the subclavian artery is completely blocked by cholesterol plaques.

Most often, blockage of the subclavian artery provokes atherosclerosis, endarteritis, nonspecific aortoarteritis. These pathologies are characterized by the formation of fatty plaques or blood clots on the walls of the vessel, which is located near the subclavian vein. After some time, the cover of the cholesterol plaque thickens and increases. Due to the blockage of the vessel, blood circulation is disturbed. The entire area for which the subclavian artery is responsible (especially the brain) suffers from a decrease in blood supply.

When a vessel is blocked, patients experience the following symptoms:

• vertigo, headache;
• wobbly gait;
• slight or severe hearing loss;
• uncontrolled oscillatory movements of the eyeballs and other visual disorders;
• numbness or tingling in the hands, muscle weakness;
• blue skin on the upper limbs, the appearance of cracks, trophic ulcers, gangrene develops;
• the patient loses consciousness or is in a pre-fainting state;
• periodically there is pain in the back of the head.

Due to a decrease in blood supply to the brain and the risk of thrombosis of its vessels, the likelihood of ischemic stroke increases.

Treatment methods

To eliminate the symptoms of occlusion, it is necessary to restore blood flow in the subclavian artery. The vessel can be reconstructed in the following ways:

• The surgeon removes the inner wall of the vessel affected by cholesterol plaques and replaces the damaged area with an implant.
• Additional blood flow paths are created to bypass the damaged areas of the vessel with the help of grafts (shunt system). For this purpose, the aorto-subclavian, carotid-axillary, carotid-subclavian, cross-axillary-subclavian shunting method is used.
• The subclavian artery is stented, expanded, and ultrasonic or laser restoration of the patency of the thrombosed vessel is performed.

The main goal of treatment is to restore blood flow in the subclavian artery

Regardless of the choice of surgical method, treatment can cause complications. So, during and after the operation, the likelihood of a stroke, damage to peripheral nerves, and impaired innervation of the eye muscles increases. In addition, surgical intervention threatens with difficulty in swallowing, lymphorrhagia (leakage of lymph through damaged vessels), swelling of the brain, and hemorrhage.

An aneurysm is a limited expansion of an arterial vessel due to damage to its walls. Due to atherosclerosis, vasculitis and other pathologies that disrupt the structure of the vessel, a certain section of the artery protrudes under blood pressure.

Aneurysm is manifested by the expansion of the subclavian artery as a result of damage to its walls

In most cases, aneurysms occur as a result of fractures, injuries, etc. After injury, blood accumulates in the tissues, a hematoma is formed, as a result, the likelihood of developing a false aneurysm, which is growing rapidly, increases. As its size increases, it compresses nearby tissues, which causes pain in the arm, blood circulation is disturbed. In addition, there is a disorder of innervation in the upper limb.

The main complication in this case is the rupture of the aneurysm and arterial hemorrhage, which often ends in the death of the victim. Also, due to impaired blood flow in the aneurysmal cavity, the likelihood of thrombosis increases. These complications provoke obstruction of the artery, circulatory disorders in the arm (pulsation slows down, the arm swells, the skin on the limb becomes pale cyanotic).

An aneurysm is a source of emboli (an intravascular substrate that causes blockage of an arterial vessel) that provokes arterial insufficiency. Due to acute circulatory disorders, there is severe pain in the arm, numbness, the patient cannot move the limb normally, it swells, turns pale. Left untreated, the risk of developing gangrene increases.

To cure aneurysms, an operation is prescribed. However, in recent years, more and more often resort to low-traumatic methods of endovascular surgery.

Atherosclerosis of the vessels of the upper extremities

This is a disease in which cholesterol plaques settle on the walls of the subclavian artery in the area of ​​​​its mouth. Pathology is manifested by stiffness of movements, painful sensations in the hands at the time of physical exertion, weakness, increased fatigue, etc. These symptoms occur due to the fact that the blood flow in the hands is disturbed or stops as a result of blockage of the artery by plaques or blood clots.

With atherosclerosis, cholesterol plaques accumulate on the walls of the subclavian artery

As the pathology progresses, the pain does not subside, even when the patient is resting. Strong painkillers are used to relieve pain.

The main factors in the development of atherosclerosis:

• Smoking.
• Arterial hypertension.
• A high concentration of low-density lipoprotein (bad cholesterol) in the blood.
• Overweight.
• Diabetes.
• Genetic predisposition to atherosclerosis.
• Passive lifestyle.
• Wrong nutrition.

To prevent the disease, it is worth giving up bad habits and leading a healthy lifestyle.

In advanced cases, atherosclerosis is treated with surgical methods:

• Sympathectomy - during the operation, a resection of the sympathetic node, which conducts the nerve impulse, is performed. As a result, the pain disappears, the blood supply to the upper extremities normalizes.
• Angioplasty is used for severe blockage of an artery. During the puncture (puncture), a needle is used, the diameter of which is 1–2 mm. At its end, a compressed balloon is placed, which is inserted into the most narrowed section of the vessel, inflated, after which its walls expand.
• Endarterectomy involves the removal of cholesterol buildup on the wall of an artery.

Surgery is resorted to only as a last resort, if the blood circulation is still normal, then atherosclerosis is treated with conservative methods.

Thus, the subclavian artery is the most important vessel that is responsible for the blood supply to the brain, neck, hands and other organs that are located in the upper body. When this vessel is damaged, dangerous pathologies arise: atherosclerosis, stenosis, occlusion, etc. Timely diagnosis and competent treatment will help save the life of the patient.