Subclavian vein

Structure

Each subclavian vein is a continuation of the axillary vein and runs from the outer border of the first rib to the medial border of anterior scalene muscle. From here it joins with the internal jugular vein to form the brachiocephalic vein (also known as "innominate vein"). The angle of union is termed the venous angle.

The subclavian vein follows the subclavian artery and is separated from the subclavian artery by the insertion of anterior scalene. Thus, the subclavian vein lies anterior to the anterior scalene while the subclavian artery lies posterior to the anterior scalene (and anterior to the middle scalene).

Function

The thoracic duct drains into the left subclavian vein, near its junction with the left internal jugular vein. It carries lymph (water and solutes) from the lymphatic system, as well as chylomicrons or chyle, formed in the intestines from dietary fat and lipids, allowing these to enter the bloodstream; the products of fats and lipids can then be carried by the bloodstream to the hepatic portal vein, and then finally to the liver. Consequently, the left subclavian vein plays a key role in the absorption of these fats and lipids.

The right lymphatic duct drains its lymph into the junction of the right internal jugular vein, and the right subclavian vein.

Clinical relevance

Central venous lines

As the subclavian vein is large, central and relatively superficial, the right subclavian vein is often used to place central venous lines. It is less commonly used than other approaches, such as the right internal jugular vein, due to the risk of pneumothorax, haemothorax, and puncture of the accompanying subclavian artery.

Thoracic outlet syndrome

The subclavian vein may be blocked in thoracic outlet syndrome. This can lead to arm swelling, pain, and cyanosis. The cause of the thoracic outlet syndrome, whether a thrombus or external pressure, must be removed immediately.

Etymology

Sub (below), and clavian (pertaining to the clavicle).

Disorders

Paget–Schroetter disease includes the thrombosis of the subclavian veins, in this case usually caused by exercise-induced strains.

Additional images

File:First rib Gray.png|Peculiar ribs. File:Venenwinkel.png|The venæ cavæ and azygos veins, with their tributaries. File:Gray599.png|The thoracic and right lymphatic ducts. File:Gray1178.png|The thymus of a full-term infant, exposed in situ. File:Slide9a.JPG|Subclavian vein File:Slide7d.JPG|Subclavian vein - right view File:Slide5dj.JPG|Subclavian vein File:Slide15d.JPG|Subclavian vein

References

References

1. Jacob, S.. (2008-01-01). "Chapter 7 - Head and neck". Churchill Livingstone.
2. (2011-01-01). "Chapter 65 - Axillosubclavian Vein Thrombectomy, Thrombolysis, and Angioplasty". W.B. Saunders.
3. "What is the Subclavian Vein? (with pictures)".
4. (2008-01-01). "Chapter 9 - Monitoring of the Heart and Vascular System". W.B. Saunders.
5. (2019-01-01). "49 - Procedures for Vascular Access". Elsevier.
6. (2007-01-01). "Chapter 204 - Central Venous Access". Mosby.
7. Sanders, RICHARD J.. (2007-01-01). "CHAPTER 53 - Subclavian Vein Obstruction: Techniques for Repair and Bypass". Academic Press.