Brachiocephalic Artery

The variations in the brachiocephalic artery are of surgical interest. If the vessel divides lower than usual, this increases the length of the first portion of the right subclavian artery. If it divides higher than usual, it may incline to the left rising in front of the trachea above the sternum. Under these circumstances the vessel is in danger during tracheostomy. When abnormally long and inclining to the left, the brachiocephalic may pass behind the trachea or the esophagus to reach the right side. It may give rise to the left common carotid, thyroidea ima artery, and more rarely the vertebral, inferior thyroid, internal thoracic (mammary) or a smaller branch such as a bronchial, thymic, pericardiac, tracheal, mediastinal, and diaphragmatic. It may also supply branches to the sternohyoid and sternothyroid. The brachiocephalic trunk is sometimes absent (0.44% of cases).

It has been reported that a brachiocephalic artery gave rise to both common carotids and to both subclavian arteries. The branching order was right subclavian and right common carotid from a common trunk, left common carotid, and left subclavian.

The thyroidea ima artery is found in 10% of subjects. It most frequently arises from the innominate trunk, but may arise from the right common carotid or from the aorta. More rarely it arises from the internal thoracic (internal mammary), or subclavian. It varies greatly in size in different individuals and compensates in varying amounts for deficiencies or absence of the thyroid arteries. It ascends in front of the trachea, and it may therefore complicate tracheostomy. See also thyroidea ima section

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