The Study Of The Anatomy, Imaging, Clinical Application Of The Subclavian Artery Puncture

Background and purposeTo study the anatomy and imaging of the structure, shape, spatial structure, and relations to surrounding tissues, as well as clinical applications of the subclavian artery (Subclavian artery, SCA) puncture. Aimed at better understanding adjacent structure and location relationship of the subclavian artery, to provide anatomy and imaging data for clinical subclavian artery puncture, and to explore the advantages of the subclavian artery puncture.MethodsAnatomy:10(7male,3females) of formalin-fixed cadavers which were intact, age unknown, were perfused with red latex from the aortic arch arterial system and blue latex from the venous system to distinguish between arteries and veins. Use needles percutaneous subclavian artery, be careful to free bilateral subclavian vein, to determine the puncture point in the surface of the projection position, the direction of the needle and theaxial and frontal plane angle of observation subclavian artery and subclavian crossoverpoint with the surrounding structure, observe the relationship of the subclavian artery and adjacent structures.Functional anatomy,50patients underwent percutaneous coronary intervention with indwelling guidewire in the subclavian artery, were instructed to do shrug action under fluoroscopic observation, to observe the shape change of subclavian artery and the proposed line range of vascular puncture point location.Imaging:200patients with combined head and neck CT angiography in using64-slice multidetector spiral computed tomography scan (computed tomography to Multisice MSCT),132cases were over the age of50,68cases were under the age of50.116cases were male,84cases were female, by means of post-processing, fully displayed bilateral subclavian artery, to observe subclavianartery and the terminal diameter, length, angle, and the observation of the subclavian artery with the adjacent structure.Results1Imaging measurements:left、right subclavian artery of the initial diameter were respectively (13.4±2.3) mm and (12.6±1.9) mm. The final end of the diameter of the left and right subclavian artery were (10±2.1) mm and (11.5±1.1) mm. Left and right subclavian artery length were respectively (51.8±0.6) mm and (43.1±0.8) mm. There was no significant difference between left and right sides of the subclavian artery (p>0.05). The distance from subclavian artery to sternoclavicular joint was (35.3±4.5) mm and the distance to the first rib was (32.5±1.8) mm. Left and right subclavian artery out of shape angle were respectively (140.5±12.5)°and (138.4±9.8)°.2Anatomical measurement data:the projection position of the vascular puncture site in the surface roughly locate at the sternoclavicular joint and the coracoid process to connect the midpoint biased about1cm at the depth of the needle (4±1.8) cm, the direction of the needle cross-sectionalangle (10±2.5)°angle with the frontal plane (25±3.2)°■. Functional anatomy, in the surgery when patients doing shrug movements (both towering to the highest level), the clavicle take the shape with the body long axis close to47°shift2～3cm the clavicle midpoint, while the scope of activities of the subclavian artery wasless than0.5cm.Conclusion:1. Subclavian artery puncture, you should select under one-third of middle and distal clavicle2～3cm place for the needle point, the direction of the needle was10° with cross-section angle and25°ith the frontal plane angle and needle depth of about4～5cm is appropriate.2. There is a similar right triangle relationship for patients with different body during the surface projection of the point of the subclavian artery, the skin and the needle point and the subclavian artery puncture target, which roughly measure the approximate depth of the needle3. In patients with tension, with due emphasis on small cross-section between the angle, will also help to puncture.4.The subclavian artery puncture in the clinical application of the dual treatment of lower limb lesions, as well as abdominal and pelvic interventional treatment has its own advantages, should be used as a conventional approach of puncture.