The brachiocephalic trunk (innominate artery) is the first and largest branch of the aortic arch and the only one on the right side. It supplies the right upper limb and the right side of the head and neck through its two terminal branches. It lies close to the trachea and the left brachiocephalic vein in the superior mediastinum.
| Origin | First and largest branch of the aortic arch, behind the manubrium |
|---|---|
| Course | Ascends upward, backward and to the right in front of the trachea and divides behind the right sternoclavicular joint into the right subclavian and right common carotid arteries |
| Branches |
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The brachiocephalic trunk crosses in front of the trachea, so it is at risk during tracheostomy, especially low tracheostomy, and a tracheo-innominate artery fistula is a rare but often fatal complication. Atherosclerotic stenosis or occlusion can cause right arm ischaemia and, through reversal of flow in the right vertebral artery, a subclavian steal pattern. Aneurysm of the trunk may present as a pulsatile mass in the suprasternal notch or with tracheal compression.
Erosion of a tracheostomy tube cuff or tip into the brachiocephalic trunk, causing a sentinel bleed followed by massive haemorrhage, requiring cuff overinflation, digital compression and emergency surgery.
Atherosclerotic or arteritic narrowing producing right arm claudication, reduced right arm blood pressure and possible vertebrobasilar symptoms, treated by stenting or surgical bypass.
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