Axillary Artery

Subclavian steal is caused by retrograde flow in the vertebral artery. It is a common angiographic or ultrasound finding when there is stenosis or occlusion of the subclavian artery proximal to the vertebral artery origin, particularly on the left, or of the innominate artery. When the ipsilateral arm is exercised, the increased blood flow to meet the metabolic demand may be enough to steal more blood down the vertebral artery, away from the brainstem into the axillary artery. If there is poor collateral blood flow to the brainstem, then symptoms may occur, but this is very rare. The subclavian disease is almost always severe enough to be detectable by unequal radial pulses and blood pressures, and often there is a supraclavicular bruit (Cho et al. 2007). 

Infusions of cisplatin into the axillary artery have led to a bronchial plexopathy rather than the more commonly described lumbosacral nerve plexus lesion (93). 

Fig. 24.11. Dissection of the axillary artery associated with a fracture of the body of the scapula. The simultaneous evaluation of osseous and vascular structures within the affected area is especially helpful in trauma (VRT image)...

The needle is inserted at an angle of 45 degrees parallel to the deltopectoral groove, l-2cm medial (Figs. 4.21 and 4.22).If the vein is not entered, fluoroscopy is then used to define the first rib. The needle is advanced and touches the first rib. Sequential needle punctures are walked laterally and posteriorly until the vein is entered. It should be noted that one cannot palpate the axillary artery pulse and, thus, it is not a reliable landmark. The axillary artery and brachial plexus are usually much deeper and more posterior structures. This simple technique using basic anatomic landmarks of the... 

Vascular ultrasound has also greatly facilitated the implant process by easing axillary vein localization. Commercially available systems (Site Rite , Bard Access Systems, Salt Lake City, UT) include either a 9 or 7.5 MHz ultrasound probe to localize the axillary artery and vein. Differentiating the vein from artery is easily accomplished by compressing the structures with probe and noting which collapses more easily (Fig. 5.3). In patients with elevated right heart pressures, this same effect can be facilitated by having the patient inspire forcefully. 

Fig. 18.35 Posteroanterior chest radiograph from an elderly patient on dipyridamole and aspirin at the time of attempted implant in the left prepectoral region. Attempted venous puncture was complicated by axillary artery puncture and bleeding. The procedure was abandoned, and a pacemaker was placed several days later via the left axillary vein. However, on this posteroanterior radiograph obtained after the left-sided implant attempt, a very large hematoma was indicated by the marked soft tissue expansion on the left thorax. In addition, an area of greater opacity in the left prepectoral region is consistent with hematoma formation in the pectoral muscle and prepectoral tissues.

Fig. 6.5. Ultrasound images of the axillary/ subclavian venous segment. Left, transverse images of the axillary artery (A.) and axillary vein (V.). (Published with permission of Lip-pincott, Williams and Wilkins). Right, longitudinal image of the axillary/subclavian vein...

Two authors have reported their experience with the PAVA or PAI technique that consists of performing proximal anastomosis to a more proximal mid-brachial or axillary artery by using a small-caliber (4 or 5 mm) or a 4-7 tapered expanded PTFE graft as feeder [28, 29]. The more proximal artery has a larger diameter, and theoretically the arterial pressure drop distal to the AVF should be significantly lower. The absence of reversed flow in the forearm arteries... 

A 52-year-old woman with Takayasu arteritis and a history of multiple sclerosis treated with IFN 3-la experienced a severe worsening of the arteritis after the reintroduction of the previously withdrawn IFN therapy. Symptoms included fever, weakness, increased inflammation and claudication in the left arm where no blood pressure or radial-ulnar pulse was measurable due to severe stenosis of the left axillary artery. Withdrawal of IFN 3-la resulted in prompt improvement of the vasculitis [56 ]. 

Bursae and Gliding Spaces 199 Neurovascular Structures 202 Suprascapular Nerve 202 Axillary Artery and Nerve 202 Thoracic Outlet Structures 202 Brachial Plexus Nerves and Vertebral Anatomy 204... 

The axillary artery continues the subclavian artery beyond the outer border of the first rib. It traverses deep to the pectoralis minor muscle and is accompanied by the cords and distal branches of the bra-... 

Proceeding toward the interscalene area, the roots of C5 and C6 join together to form the upper trunk, the root of C7 emerges by itself as the intermediate trunk and, in the lower neck, the roots of C8 and Tl form the lower trunk of the plexus. More distally, in the supraclavicular region, each trunk gives off two divisional branches, named the anterior and posterior divisions, which innervate the flexor and extensor muscles of the upper extremity respectively. In the axilla, these divisions join in various combinations to form the cords of the brachial plexus. The relationship of the cords with the axillary artery determines their names the lateral, medial and posterior cords. The axillary and radial nerves originate from the posterior cord, the musculocutaneous and part of the median nerve arise from the lateral cord, vdiereas the other contribution of fibers to the median nerve and the ulnar nerve originate from the medial cord. 

Fig. 6.61a,b.Normal brachial plexus infraclavicular region. Oblique transverse 12-5 MHz US images obtained under the clavicle a over the major axis of the axillary artery (AA) and b immediately behind it. The cords of the brachial plexus (open and white arrowheads) are visualized as elongated fascicular structures coursing around the axillary artery and deep to the pectoralis minor muscle (Pm). PMj, pectoralis major muscle. The insert at the upper left side of the figure indicates transducer positioning... 

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