4/11/2024 0 Comments Hard signs neck traumaThe embryologic origin of the left subclavian artery is the left seventh intersegmental artery. The left subclavian artery has a different anatomic pattern, which influences the surgical approach. Common anatomic variations include the artery arises below the sternoclavicular joint and the right subclavian artery arising directly from the aorta. The right subclavian artery arises from the innominate artery typically above the sternoclavicular joint, where it branches into the right subclavian artery and the carotid artery. The embryologic origin of the right subclavian artery is from the right fourth aortic arch, the right dorsal aorta, and the right 7th intersegmental arteries. The third portion of the artery is the most accessible surgically. Injury to the proximal portion of the artery is rarely caused by blunt trauma due to its location deep within the chest cavity. The first portion of the subclavian artery lies near the internal jugular vein, carotid artery, vagus nerve, and the phrenic nerve. Each subclavian artery is divided into three parts: the first portion includes the vessel origin from the aorta to the medial border of the anterior scalene muscle, the second portion is behind the anterior scalene muscle, and the third portion extends from the lateral anterior scalene muscle to the lateral border of the first rib. Distally, at the lateral border of the first rib, the subclavian artery becomes the axillary artery. Despite differences in the anatomic course and origin of the right and left subclavian arteries, the branches are similar bilaterally and include the vertebral artery, the internal thoracic artery, the thyrocervical trunk, the costocervical trunk, and the dorsal scapular artery. It is important to understand the anatomic variability in the origin of the subclavian arteries to undertake the optimal surgical approach. The significant anatomic protection of the subclavian arteries makes operative intervention challenging. However, the presence of a scapular fracture in a pediatric patient should raise the suspicion of a subclavian artery injury. Subclavian injuries from trauma are rarely reported in the pediatric population due to the increased elasticity of the chest wall and vessels. The subclavian arteries are protected by the skin, the clavicle, the superficial fascia, platysma, the supraclavicular nerves, and deep cervical fascia. This type of injury will not be discussed in this review. Iatrogenic injury of the subclavian artery can also occur due to a failed central venous catheter placement attempt. Subclavian artery injuries from penetrating trauma are associated with an increased mortality rate, whereas blunt trauma has a higher morbidity rate due to injury to surrounding structures. In blunt trauma, complete brachial plexus injuries are more common, usually secondary to a fall on an outstretched hand. Associated injuries also vary by mechanism. Penetrating trauma more commonly results in the formation of a pseudoaneurysm. While blunt mechanisms are less common than penetrating, subclavian artery injuries caused by blunt trauma are being reported in the literature more frequently due to the increasing use of imaging for diagnosis. Due to the protected anatomic location of the subclavian vessels, most subclavian artery trauma is usually caused by a penetrating mechanism secondary to firearm injuries or knife wounds.
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