Rahimi Osman, Geiger Zachary
Western University of Health Sciences
Western Reserve Hospital
The subclavian arteries lie just below the clavicles, providing blood supply to the bilateral upper extremities with contributions to the head and neck. The right subclavian artery derives from the brachiocephalic trunk, while the left subclavian artery originates directly from the aortic arch. The subclavian arteries course laterally between the anterior and middle scalene muscles. The distal limit of the subclavian artery is the lateral border of the first rib, where it becomes the axillary artery. Additional branches of the subclavian arteries include the internal thoracic artery, vertebral artery, costocervical trunk, thyrocervical trunk, and the dorsal scapular artery. During development, the left subclavian arises from the seventh intersegmental artery and the right subclavian develops in segments; proximally from the fourth aortic arch, medially from the dorsal aorta and distally from the seventh intersegmental artery. Multiple aspects of the nervous system travel alongside or near the subclavian arteries. They include the sympathetic trunk, the vagus nerve, parts of the brachial plexus, the phrenic nerve and the right recurrent laryngeal nerve. Alongside these neuronal pathways, the arteries are also linked closely to venous pathways such as the internal jugular veins and vertebral veins. These vessels make an interconnected highway that helps fuel the cellular processes used by the neck and upper extremity muscle groups, the brain and thyroid gland. Clinically the subclavian arteries can be host to numerous congenital and idiopathic pathologies which can be managed with physical rehabilitation and/or surgical interventions. The most common congenital anomaly is an aberrant subclavian artery which is usually a benign condition but can be symptomatic in twenty percent of cases. Within the musculoskeletal system, a condition known as thoracic outlet syndrome involves stenosis of the middle or distal ends of the arteries and can cause impeded flow to the distal tributaries. This lack of flow can manifest and weakened pulses and lead to hosts of neurological and ischemic changes in the upper extremities. If affected primarily within the arteries themselves pathologies such as Takayasu arteritis may manifest leading to inflammatory changes within the major branches of the aortic arch, including the subclavian arteries, and can clinically be seen with bilateral bruits heard in the upper lateral anterior thorax accompanied by ischemic changes to either the head and neck or the upper extremities. Another primary issue seen with the subclavian arteries is the aptly named subclavian steal syndrome which involves primary stenosis of an artery leading to retrograde flow down the opposite subclavian artery from the vertebral arteries (arising from the subclavian arteries) leading to a "steal" of blood flow from the circle of Willis, which supplies blood to the brain. Although rare, some other issues include subclavian arterial aneurysms or congenital stenosis of either artery due to redundant tissue or an aberrant variation in the anatomical location of bones and nerves.
锁骨下动脉位于锁骨下方，为双侧上肢供血，并为头颈部供血。右锁骨下动脉发自头臂干，而左锁骨下动脉直接起自主动脉弓。锁骨下动脉在前斜角肌和中斜角肌之间向外走行。锁骨下动脉的远端界限是第一肋的外侧缘，在此处它延续为腋动脉。锁骨下动脉的其他分支包括胸廓内动脉、椎动脉、肋颈干、甲状腺颈干和肩胛背动脉。在发育过程中，左锁骨下动脉起自第7节段间动脉，右锁骨下动脉分段发育；近端起自第四主动脉弓，中间起自背主动脉，远端起自第7节段间动脉。神经系统的多个部分与锁骨下动脉并行或靠近。它们包括交感干、迷走神经、臂丛的部分分支、膈神经和右喉返神经。沿着这些神经通路，动脉还与静脉通路紧密相连，如颈内静脉和椎动脉。这些血管形成了一个相互连接的通道，有助于为颈部和上肢肌肉群、大脑和甲状腺的细胞活动提供能量。临床上，锁骨下动脉可出现多种先天性和特发性病变，可通过物理康复和/或手术干预进行治疗。最常见的先天性异常是迷走锁骨下动脉，通常为良性病变，但20%的病例可能有症状。在肌肉骨骼系统中，一种称为胸廓出口综合征的疾病涉及动脉中、远端的狭窄，可导致远端分支血流受阻。这种血流不足可表现为脉搏减弱，并导致上肢出现一系列神经和缺血性改变。如果主要影响动脉本身，如大动脉炎等病变可能会出现，导致主动脉弓主要分支（包括锁骨下动脉）的炎症改变，临床上可在上胸部外侧前部听到双侧血管杂音，并伴有头颈部或上肢的缺血性改变。锁骨下动脉的另一个主要问题是恰如其分地命名为锁骨下动脉盗血综合征，它涉及动脉的原发性狭窄，导致血液从椎动脉（起自锁骨下动脉）沿对侧锁骨下动脉逆行流动，从而导致从为大脑供血的Willis环“窃取”血流。虽然罕见，但其他一些问题包括锁骨下动脉动脉瘤或由于多余组织或骨骼和神经解剖位置异常变异导致的任何一条动脉的先天性狭窄。
