Brachiocephalic Artery Anatomy

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The brachiocephalic artery is a blood vessel that originates from the aortic arch . It supplies blood flow to the right carotid artery and the right subclavian artery. It is also known as the unnamed artery or the brachiocephalic trunk. The name refers to the fact that blood flows through this very short artery to the arm (brachium) and head (cephalic). It is an artery, that is, a thick-walled blood vessel through which blood is transported from the heart. It can also be called a trunk because it is the base of two other very important arteries.

Anatomy

The length of the brachiocephalic artery from the aortic arch to the point where it branches into the right subclavian artery and the right carotid artery is only about 4-5 centimeters (cm). It begins at the point where the ascending aorta begins to curve toward the aortic arch, just along the midline.

The brachiocephalic artery branches into the right subclavian artery and the right carotid artery.

There is only one brachiocephalic artery and it only feeds the right arm and the right hemisphere of the brain.

In the left arm and the left side of the brain, blood comes from two other arteries that are attached to the distal (downstream) aortic arch of the brachiocephalic artery.

The brachiocephalic artery is above the aortic arch and below the thymus. The trachea lies directly between the brachiocephalic artery and the left common carotid artery. The brachiocephalic artery follows the right side of the trachea to the level where the clavicle meets the sternum.

The brachiocephalic artery extends to the right arm in an almost straight line, with the right common carotid artery rising just behind the sternoclavicular joint.

BJI / Blue Jean Images / Getty Images

Anatomical variations

A congenital variant of the aortic arch that affects the brachiocephalic artery is called the bovine arch. This change occurs in 27% of the population and is more common in African Americans .

The cattle arch is so named because the branches of the brachiocephalic artery and the left common carotid artery originate together in the arch of the aorta and do not separate, as is often the case. On an X-ray, everything looks a bit like the head of a horned cow. There are two additional variants of the bullish arc that are much less common.

Most of the anatomical variants of the brachiocephalic artery are asymptomatic (without medical complaints).

Function

The brachiocephalic artery carries blood from the aorta to the right side of the brain and to the right arm. It is a large blood vessel that provides most of the blood flow to these areas.

Although there are two arms and two sides of the brain, the brachiocephalic artery only occurs once and supplies only the right arm and the right side of the brain. The left common carotid artery, which supplies the left brain, and the left subclavian artery, which supplies the left arm, do not join and both arise along the aortic arch distal to the brachiocephalic artery.

Despite the size of the brachiocephalic artery, it plays an important role in regulating pressure by controlling blood flow between the aortic arch and the right common carotid artery.

In some bypass grafts, in which the brachiocephalic artery is bypassed and blood is transferred directly from the aortic arch to the carotid artery, blood flow to the carotid artery stimulates the baroreceptors there, causing a significant drop in blood pressure. blood pressure

Clinical significance

The brachiocephalic artery and the subclavian artery are the most common injuries that cause narrowing (stenosis) and restrict blood flow to the upper extremities. Brachiocephalic stenosis can cause pain in the right arm during exertion, vision problems, and transient ischemic attacks .

The more distal (lower) narrowing of the blood vessels can lead to a condition called subclavian steal syndrome , in which blood is intercepted from the brain and sent to the arm. Subclavian steal syndrome can cause stroke-like neurological symptoms and is usually aggravated by exercise that forces the arm to increase blood flow.

Often referred to as unnamed arterial disease, brachiocephalic artery narrowing and occlusion can be treated with a variety of surgical techniques.

  • Endarterectomy is a surgical procedure used to remove plaque from inside the arteries. It is often used on the carotid arteries to prevent a stroke.
  • Angioplasty is the use of an inflated balloon inside narrow arteries to force them open. Once the artery is open, a stent is placed to hold it there. The stent looks a bit like a small spring.
  • In bypass graft , a segment of another blood vessel is transplanted to a point proximal (upstream) and distal (downstream) of the brachiocephalic artery occlusion. This allows blood to flow around (bypass) the occlusion.

Brachiocephalic artery aneurysm is rare but clinically significant. The brachiocephalic artery is the site of aneurysms in 3% of all supra-aortic aneurysms. These aneurysms can grow and put pressure on surrounding tissues and structures, causing difficulty swallowing or shortness of breath. They can also create blood clots that can travel downstream to more distant locations. Doctors usually treat brachiocephalic artery aneurysms with surgery.

Anatomic variations in the brachiocephalic artery are usually asymptomatic, but they are common and present an increased risk of rupture and ischemia (restriction of blood circulation) during chest surgery. It is important that people who know they have a variation tell their doctors, especially if surgery is possible.

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