The Variable Course of Subclavian and Axillary vessels in relation of Thoracic Outlet Syndrome and Breast Cancer Metastases

Waseem Al Talalwah

Axillary Vein Variation, Axillary Artery Variability, Breast Cancer Metastases, Iatrogenic Injury of Axillary vessels,Cervical rib, Scalenus anterior.

Background: The axillary artery is a standard continuation of subclavian artery.Objectives: The purpose of current study is to identify the variable origin and course of the axillary artery as well as the axillary vein drainage and its course with their clinical significant.Material and method: The present study includes 79 female cadavers have been dissected carefully to observe the anatomical features of axillary artery and vein. Result:The current study showed the axillary artery arises from the subclavian artery as well asthe axillary vein drains into subclavian vein in 98.7%. Therefore, 1.3% the axillary artery arose from the brachiocephalic trunk and its vein drained into brachiocephalic vein. In the present variation, the axillary vein and artery as well as the brachial plexuses run below the second ribs from ventral to dorsal direction. Further, the axillary artery originating from subclavian artery penetrated the scalenus anterior in 1.9% in present study. Conclusion:This study presents unusual course of the axillary artery and vein as well as the brachial plexus and accounts their incidences in female Caucasian population. The clinical significant is direct extension of breast cancer to the current neurovascular variations which may present with different clinical pictures. Further, the axillary artery and vein with the brachial plexusmay be in high risk of ribs entrapment result in thoracic outlet syndrome. Moreover, radiologists have to be completely aware of thevascular variation to report. This radiologist’s report might help the surgeons to avoid iatrogenic injury of the axillary vein and artery leading to threatening hemorrhage.