Arteries of the Upper Extremity

This artery arises from the brachiocephalic trunk at the right side, from the division of the brachiocephalic trunk (part I), behind the right sternoclavicular joint passing upward behind the scalenus anterior muscle (part II), and coursing horizontally slightly downward to the outer border of the first rib (part III), about the origin of the superior thoracic artery (Figs. 15.1, 15.2).

The left subclavian artery arises from the aortic arch, after the origin of the left common carotid artery at the level of the third and fourth thoracic vertebra, ascending in the direction of the neck and bending laterally crossing behind the left scalenus anterior muscle (part I), following the same pattern as that of the right subclavian artery on parts II and III.

Subclavian Artery

Branches

Vertebral artery
Internal thoracic artery (internal mammary artery)
Thyrocervical trunk
Costocervical trunk
Dorsal scapular artery

Vertebral Artery

This artery is described in the head and neck section (Chapter 2).

Internal Thoracic Artery (Internal Mammary Artery)

This artery arises within 2 cm of the origin of the subclavian artery. It courses forward and downward behind the cartilages of the upper ribs and divides into the musculophrenic and superior epigastric arteries at the level of the sixth intercostal space (Figs. 15.3, 15.4, 15.5).

Branches

Pericardiophrenic artery
Mediastinal artery
Pericardial branches
Intercostal branches
Perforating branches
Musculophrenic artery
Superior epigastric artery

Thyrocervical Trunk

The thyrocervical trunk arises from the first part of the subclavian artery and gives rise to three branches (Fig. 15.2).

Inferior Thyroid Artery (Figs. 15.6, 15.7)

Branches

Muscular branches
- Ascending cervical artery
- Inferior laryngeal artery
Pharyngeal branches
Tracheal branches
Esophageal branches
Large glandular branches
- Ascending (parathyroid)
- Descending (thyroid)

Variation: A bronchial artery may originate from the thyrocervical trunk (Fig. 15.8).

Suprascapular Artery (May be a branch of the Subclavian or Internal Thoracic Artery (Figs. 15.9, 15.10, 15.11)

Branches

Suprasternal branch
Acromial branch
Articular branches
- Clavicle nutrients
- Scapula nutrients

Superficial Cervical Artery (Fig. 15.12)

This artery anastomoses with the superficial branch of the descending branch of the occipital artery.

Costocervical Trunk

The costocervical trunk arises from the back of the second part of the subclavian artery on the right side, but on the first part on the left side (Fig. 15.13).

Superior Intercostal Artery

The superior intercostal artery anastomoses with the third posterior intercostal artery. It may be supplied by a branch from the aorta.

Deep Cervical Artery

The deep cervical artery arises in most cases from the costocervical trunk but may be a branch of the subclavian artery.

Dorsal Scapular Artery (Figs. 15.14, 15.15)

This artery arises from the third or second part of the subclavian artery.

Axillary Artery (Figs. 15.1, 15.2, 15.3, 15.16)

The axillary artery is a continuation of the subclavian artery.

Proximal limit—outer border of the first rib.
Distal limit—lower border of the tendon related to the teres major muscle or muscle’s tendon.

Branches

Superior thoracic artery (highest)
Thoracoacromial (acromiothoracic) artery
- Pectoral branch
- Acromial branch
- Clavicular branch
- Deltoid branch
Lateral thoracic (lateral mammary branches)
Subscapular artery
Anterior circumflex humeral artery
Posterior circumflex humeral artery

Superior Thoracic Artery (Highest Thoracic Artery or Arteria Thoracica Suprema)

The superior thoracic artery is a small vessel and arises from the first part of the axillary artery. It may branch from the thoracoacromial artery.

Thoracoacromial Artery (Acromiothoracic Artery) (Figs. 15.17, 15.18, 15.19)

Branches

Pectoral branch
Acromial branch
Clavicular branch
Deltoid branch (may arise from the acromial branch)

Lateral Thoracic Artery (External Mammary or Inferior Thoracic Artery)

This artery anastomoses with the internal thoracic, subscapular, and intercostal arteries and pectoral branches of the thoracoacromial artery. In females, it is larger and gives off lateral mammary branches reaching the breast.

Subscapular Artery (Inferior Scapular Artery)

This artery is the largest branch of the axillary artery. It anastomoses with the lateral thoracic, intercostal arteries and deep branch of the transverse cervical artery, and supplies muscles of the chest wall.

Branches

Circumflex scapular artery
Infrascapular artery
Lateral border of the scapula (dorsal thoracic artery)
Muscular branches

Anterior Circumflex Humeral Artery

This artery is a small branch that is located in front of the surgical neck of the humerus. It supplies the head of the humerus and shoulder joint and may have common origin with the posterior circumflex humeral artery.

Posterior Circumflex Humeral Artery (Figs. 15.2, 15.3, 15.16)

This artery is larger than the anterior circumflex humeral artery. It arises from the third part of the axillary artery and winds around the surgical neck of the humerus and distributes branches to the shoulder joint, deltoid, teres major and minor, and long and lateral heads of triceps. The descending branch anastomoses with the deltoid branch of the arteria profunda brachii, the anterior circumflex humeral artery, and with the acromial branches of the suprascapular and thoracoacromial arteries.

Alar Thoracic Artery (Variation)

The subscapular, circumflex humeral, and profunda brachii arteries may arise as a common trunk (Fig. 15.20). The axillary artery may divide into radial and ulnar arteries or give off the anterior interosseous artery of the forearm. The radial artery may arise from the distal axillary artery (Fig. 15.19). The arteria profunda brachii may originate from the axillary artery (Fig. 15.21A). The subscapular, the lateral thoracic, and pectoral arteries may be part of a common trunk (Fig. 15.21B).

Brachial Artery

The brachial artery is the continuation of the axillary artery. It begins at the lower border of the tendon of the teres major, ending 1 cm below the elbow, dividing into radial and ulnar arteries. It runs down the arm, medially to the humerus and gradually moving to the front of the bone (Figs. 15.21, 15.22, 15.23, 15.24, 15.25, and 15.26).

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