The supreme (superior) intercostal artery is a branch of the costocervical trunk that supplies the top two intercostal spaces. It descends behind the pleura in front of the necks of the first and second ribs. It gives off the first and second posterior intercostal arteries, because the aorta lies too low to supply these spaces directly.
| Origin | Costocervical trunk, a branch of the second part of the subclavian artery |
|---|---|
| Course | Descends behind the cervical pleura and in front of the necks of the first and second ribs |
| Branches |
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The supreme intercostal artery lies close to the cervicothoracic sympathetic ganglion and the T1 nerve root at the neck of the first rib, so it is encountered in first rib resection for thoracic outlet syndrome and in upper thoracic sympathectomy. Injury causes troublesome bleeding in a confined space. In coarctation of the aorta it contributes to the collateral circulation that bypasses the narrowing.
Removing the first rib for thoracic outlet syndrome can injure the supreme intercostal artery near the rib neck, causing bleeding that is difficult to reach through a small incision.
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