Brachiocephalic Veins

venae brachiocephalicae

The right and left brachiocephalic (innominate) veins are formed by the union of the internal jugular and subclavian veins on each side. The right brachiocephalic vein is approximately 2.5 cm long and passes nearly vertically downward. The left brachiocephalic vein is approximately 6 cm long and crosses the anterior mediastinum horizontally behind the manubrium before joining the right to form the superior vena cava. The left vein crosses anterior to the great arterial branches of the arch.

Region: Chest

Clinical Relevance

Clinical Notes

The left brachiocephalic vein is the predominant site for permanent central venous catheter insertion via the left subclavian or internal jugular approach, as its longer horizontal course provides a gentler angle for catheter advancement into the SVC. It is at risk during median sternotomy, thymectomy, and anterior mediastinal surgery where it crosses the operative field. Superior vena cava syndrome from mediastinal tumour compression produces bilateral brachiocephalic engorgement, facial and arm oedema, and raised JVP.

Pathology

Common Injuries & Conditions

SVC Syndrome from Brachiocephalic Compression

Mediastinal lymphoma or lung cancer compressing both brachiocephalic veins at their junction produces superior vena cava syndrome with facial plethora, arm swelling, engorged neck veins, and headache, managed by steroids and radiotherapy or endovascular stenting for rapid symptom relief.

Brachiocephalic Vein Injury in Sternotomy

The left brachiocephalic vein crossing anterior to the aortic arch behind the manubrium is at risk during median sternotomy and re-sternotomy for cardiac surgery, where adhesion of the vein to the posterior sternum after previous surgery makes saw-cutting dangerous.