The subclavian arteries are vessels; they carry blood to the upper limbs of the human body. This article will examine in detail all the basic concepts on this topic. 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 receiving blood from the aortic arch - the subclavian artery - refers to the vessels of a large circle of blood circulation of a person. It supplies blood to the occipital regions of the brain, cerebellum, cervical spinal cord, muscles and partially organs of the neck, shoulder girdle and upper limb, as well as some parts of the chest and abdominal cavity.
Topography of the subclavian artery
What does the word "topography" mean ? This is a literal finding or arrangement 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 relative 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 nerve plexus and is located on the surface. This location of the vessel allows you to use it to stop possible bleeding or enter medications. Further, the subclavian artery bends through the rib, passes under the collarbone and enters the axilla, where it already becomes axillary. Then, after passing through the armpit, she goes on the shoulder. The name of this site 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, on the neck, the subclavian vein (and the artery too) lie on the surface. It is this place that is used to take a puncture, insert a catheter. What justifies the choice of this particular part of the vessel? There are several criteria for this choice:
- Anatomical accessibility.
- Stability and clearance.
- Sufficient or significant size (diameter).
- Blood flow exceeds the speed of blood in the veins of the limbs.
Based on the data presented above, a catheter inserted into a vein will almost not touch the walls of the artery. The medications that are injected through it will quickly reach the right atrium and ventricle, they contribute to an active effect 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 puncture and insertion of a catheter.
Left and right subclavian artery
This vessel is a paired organ, as mentioned above: the right subclavian artery and the left. The first is the final branch of the brachiocephalic trunk, as for the left, it leaves the aortic arch. In addition, the latter is approximately 4 cm longer than the former. The right subclavian artery supplies blood to some parts of the right hand, supplies it to the head and chest. The left subclavian artery transfers fluid carrying important substances for life support to the left hand.
The main divisions of the subclavian artery
The left and right subclavian artery are divided conditionally into three main departments, or sections:
- From the site of subclavian artery formation to the entrance to the interstitial space.
- A department that is limited specifically 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 how the subclavian artery and its branches look, that is, to which parts this vessel branches. Several branches leave from its first section (the place between the entrance to the interstitial space and the beginning of the artery), these are the main ones:
- Vertebral artery, steam room. It passes through the transverse process of the sixth cervical vertebra. Then it rises to the top and enters the cranial cavity through the back of the head, that is, through its opening. Then it connects to 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 thoracic artery begins on the lower part of the subclavian artery. The channel supplies blood to the thyroid gland, diaphragm, bronchi, sternum, etc.
- Thyroid barrel. It originates near the inner edge of the scalene muscle, reaches a length of about 1-2 cm. The thyroid shaft is divided into branches that supply blood to the muscles of the scapula and neck, as well as the larynx.
Branches of the second and third subclavian artery
The second section of the subclavian artery, limited by the interstitial gap, has only one branch, it is called the costal-cervical trunk. It begins on the back of the subclavian artery and is divided into several branches:
- The highest intercostal artery (posterior branches leading from the artery to the back muscles depart from this artery).
- Spinal vessels.
- Deep cervical artery.
The third section of the subclavian artery also has one branch - this is the transverse neck artery. It permeates the shoulder meeting and is divided into:
- The superficial artery that supplies blood to the spinal muscles.
- Dorsal artery of the scapula. It descends to the broad muscle of the back, nourishes it and the nearby small muscles.
- The deep branch of the subclavian artery .
Here, concepts such 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 a narrowing of the lumen of the vessels, in other words, stenosis. The main cause of this ailment 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 the occurrence of atherosclerosis of the subclavian artery are:
- Arterial hypertension.
- Smoking.
- Overweight, obesity.
- Diabetes mellitus and some other diseases.
The most common cause of stenosis of the subclavian artery is a metabolic disorder in the human body, neoplasms and inflammatory processes. Severe stenosis leads to a decrease in blood flow to the vital organs of a person, a deficiency of oxygen and nutrients in the tissues appears. In addition, stenosis can cause coronary artery disease, in particular stroke.
Subclavian artery syndrome
Insufficient blood flow can be caused not only by obstruction of blood flow due to occlusal stenotic lesions, but also by vertebral subclavian "robbery". This subclavian artery syndrome, or steel syndrome, develops in the event of stenosis or occlusion in the first section of this vessel. Simply put, blood does not enter the subclavian canal from the aorta, but from the vertebral artery, which can lead to cerebral ischemia. The maximum manifestations of this disease cause physical exertion on the upper limb.
Symptoms of the disease:
- Dizziness.
- Fainting conditions.
- Visual impairment.
- Muscle weakness on the affected side.
- Weakening or complete absence of pulse on the affected side.
More about stenosis of the subclavian artery
Deposits on the walls of blood vessels leading to a narrowing of the latter have a lipid base, that is, in fact, these are derivatives of cholesterol. These deposits can narrow the lumen of the vessel to 80%, sometimes even completely plug it. In addition to the above factors causing stenosis of the subclavian artery, there are others, such as:
- Irradiation.
- Arteritis.
- Compression syndromes.
- Various lesions, for example, fibro-muscular dysplasia, etc.
Very often, in people suffering from stenosis of the subclavian artery, other vessels are affected. It can be both coronary channels, that is, cardiac, and carotid - arteries of the lower extremities. Basically, with such a pathology as a narrowing of the lumen of the vessels, the left subclavian artery is affected. According to statistics, this happens several times more often than on the right.
Symptoms of stenosis:
- Muscle weakness.
- Feeling tired.
- Pain in the upper limbs.
- Necrosis of the fingers.
- Bleeding in the nails.
In addition, neurological symptoms may appear, that is, "robbery" occurs: blood is redirected from normal vessels to the affected area. Symptoms of neurological diseases:
- Visual impairment.
- Loss of consciousness.
- Speech impairment.
- Loss of balance.
- Dizziness.
- Loss of sensitivity in the face.
How to treat subclavian artery stenosis?
Treatment for stenosis can be medication, surgery and interventions. 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 which it is difficult to distinguish the first section of the artery. Also, this treatment method is recommended for stenosis in the second section of the subclavian artery.
Subclavian artery stenting
Stenting is the treatment of the subclavian artery through a small incision on the skin, 2-3 mm long, it is done through a puncture hole. This method of therapy has several advantages over surgical intervention, as it causes fewer injuries and discomfort. In addition, this is the most gentle and organ-preserving method of treatment, in which the subclavian artery remains in its original form, which is very important for the patient.
The stenting procedure is almost 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 in a compressed state is advanced in the subclavian artery. When the stent reaches the narrowing zone of the vessel, some control procedures are performed associated with its correct location. After that, the device opens under high pressure. If the stent is not sufficiently opened, angioplasty of the stented area is performed with a special catheter with a balloon at the end for optimal achievement of the result. Today it is possible to perform this operation for free, it can be done by receiving a federal quota. A patient with a similar disease must consult a physician.
Possible risks when stenting
The procedure for stenting the subclavian artery lasts about 2 hours. This operation is performed in the cardiac catheterization department. After stenting, painkillers are taken if necessary, since painful sensations may occur in the place where the subclavian artery and tissues were incised. Complications after this procedure are very rare, since the patient before her undergoes thorough preparation and observation. But still, some unpleasant consequences may occur, this:
- Allergy to medications.
- Reaction to anesthetics.
- Slight bleeding at the incision site.
- Temperature.
- Headache.
- Infection.
- Air embolism.
- Damage to the wall of an artery or aorta.
- Subclavian artery thrombosis.
- Stent migration.
- Neurological complications, etc.
Interventional treatment of subclavian artery stenosis with balloon angioplasty and stenting are modern minimally invasive and effective methods of therapy. They have a very short postoperative period and hospitalization.