Development and anatomy of the venous system
Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki in Handbook of Venous and Lymphatic Disorders, 2017
The axillary vein begins at the lower border of the teres major, which corresponds with the lateral border of the scapula on an anteroposterior chest roentgenogram. At the outer border of the first rib, it becomes the subclavian, which ends at the medial border of the scalenus anterior muscle, where it joins the internal jugular vein to form the brachiocephalic vein. The brachiocephalic (innominate) vein begins behind the sterno-clavicular joint. The left brachiocephalic vein descends obliquely to join the right one. Constant tributaries of the brachiocephalic vein are the vertebral, internal thoracic, and inferior thyroid veins. The superior intercostal vein drains the upper intercostal veins and opens into the brachiocephalic vein on the left, whereas on the opposite side it joins the azygos vein.
Upper Limb
Bobby Krishnachetty, Abdul Syed, Harriet Scott in Applied Anatomy for the FRCA, 2020
Deep venous systemThe deep veins of the upper limb lie underneath the deep fascia. Distally, paired veins lie on either side of the artery but as they continue proximally, the paired vessels merge to form a single vein.The axillary vein drains the shoulder, arm, forearm, hand and lateral chest wall.The subclavian vein, the continuation of the axillary vein, also receives the venous drainage from the scapular region and joins the internal jugular vein to ultimately form the brachiocephalic vein (Figure 5.4).
Upper Limb
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno in Understanding Human Anatomy and Pathology, 2018
In general the arteries and veins of the human upper limb have similar configurations and analogous names. Therefore, gross anatomy students are usually encouraged to focus more on the arteries and to study in detail only the veins that differ markedly from the arteries. The superficial veins of the upper limb, and particularly of the forearm and arm, are examples of veins that have no clear analogs in the arterial system (Plate 4.4). The axillary vein is the major deep vein at the level of the axillary (or arm-pit) region. It is joined by the cephalic vein, so named for its direction of drainage toward the head, within the deltopectoral triangle (Plate 4.5b). Apart from these connections with the axillary vein, the superficial veins are also connected to the other deep veins via the perforating veins. The cephalic vein then continues superficially to pass into the deltopectoral groove between the deltoid and pectoralis major muscles. In the cubital fossa of the elbow region, the median cubital vein connects the cephalic vein and the basilic vein (which emerges from beneath the brachial fascia just proximal to the elbow and forms a network of veins surrounding the brachial artery). The boundaries of the cubital fossa are: lateral (brachiora-dialis), medial (pronator teres), superior (imaginary line connecting medial and lateral humeral epicondyles), superficial (antebrachial fascia), and deep (brachialis and supinator). The basilic and cephalic veins anastomose in the hand via the dorsal venous arch, which collects venous drainage from the posterior (dorsal) surface of the hand and digits.
Superficial location of the brachial plexus and axillary artery in relation to pectoralis minor: a case report
Published in Southern African Journal of Anaesthesia and Analgesia, 2018
The axillary artery is a continuation of the subclavian artery once it has passed over the first rib. The pectoralis minor muscle is located superficial to the axillary artery and it is this relationship that is used to divide the artery into three parts. The first part of the axillary artery is situated between the first rib and the superior border of pectoralis minor, the second part is deep to pectoralis minor, and the third part is located between the inferior borders of pectoralis minor and teres major muscles, after which it is known as the brachial artery.5 The axillary artery is accompanied by the axillary vein, a continuation of the brachial vein at the inferior border of teres major. The axillary vein is superficial to the axillary artery and becomes the subclavian vein as it crosses over the outer border of rib one.6
A simple method of axillary venipuncture using single landmark for pacemaker leads implantation
Published in Acta Cardiologica, 2023
Peng Zhao, Ying Wang, Shan Zeng
The patient was placed in supine position. Skin was cleaned and drape applied in the conventional fashion. Connecting point of medial to middle third of clavicle was located as the sole external anatomical landmark and puncture guiding point. Deflected lateral 45° from sagittal line, an 18-gauge needle was laid on the point, tip tangential to upper border of clavicle. The site of needle hub was identified as puncture entry point. Axillary vein was punctured by advancing the needle attached to syringe from entry site towards the landmark, with continuous suction and at approximately 30–45°relative to body surface. If not touching the vein, the needle was withdrawn and the procedure was repeated with slight lateral or medial variations to the landmark. Care was taken to not cross intercostal space in order to avoid pneumothorax. Upon blood aspiration, antero-posterior fluoroscopic view was used to confirm venous access site below the inferior border of clavicle and a guide wire was inserted from axillary vein into inferior vena cava, which counted as a successful procedure. If blind puncture failed after a maximum of five times, an alternative fluoroscopic assisted method was applied. Using antero-caudal fluoroscopic view with no cranio-caudal tilt orientation, the needle was inserted from entry point towards the first rib and outside the inferior margin of clavicle, as a modified version of the technique by Antonelli [7]. After successful venipuncture, a skin incision was made at the puncture site Figure 1. The remainder of subcutaneous pocket and device implantation was carried out in a routine manner.
Alternative Access for Mechanical Circulatory Support
Published in Structural Heart, 2020
Mir B. Basir, Marvin H. Eng, Pedro Villablanca, Mark B. Anderson, Mohammad Zaidan, Dee Dee Wang, Khaldoon Alaswad, William W. O’Neill, Mohammad Alqarqaz
Basic understanding of AxA anatomy is essential for safe percutaneous access and closure. The AxA begins at the lateral border of the first rib as a direct continuation of subclavian artery and ends at the lower border of the teres major muscle by continuing as the brachial artery. For descriptive purposes, the artery is divided into three segments according to its course in relation to the pectoralis minor muscle. The first (proximal) part is medial, the second (middle) part is posterior and the third (distal) part is lateral to the pectoralis minor muscle. Several side branches arise from these segments as shown in Figure 5. Important anatomical relations include the axillary vein which runs medial to the AxA and the proximity of the AxA to the brachial plexus, particularly in its third part where the median nerve roots are located anterior to the artery.