The subclavian artery is so deeply placed, its connexions with important parts are so intimate and varied, and the branches are so large in proportion to the length of the trunk, that operations on this vessel present, in most cases, considerable difficulties to the surgeon. But the difficulties, it will be found, vary in different cases.
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In the operation for tying the brachial artery, the known direction of the vessel, and the inner margin of the biceps muscle chiefly aid in determining its position. In consequence of the thinness of the parts which cover the artery, and the position of the basilic and median basilic veins, with respect to it. even the integuments must be divided with care.
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In the neck the internal carotid artery usually gives no branch ; whilst within the carotid canal it sends a small offset to the tympanum, which anastomoses with the tympanic and stylo-mastoid arteries; within the cavernous sinus, some small branches, named arteries receptaculi, proceed from it to supply the walls of the sinus and the adjacent dura mater. One of these, distributed to the dura mater, is the anterior meningeal.
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The brachial artery gives some unnamed branches, which are directed outwards and backwards to the muscles in its immediate neighbourhood, viz., to the coraco-brachialis, biceps, and brachialis anticus; the following, which incline inwards, have received names, and require description.
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The internal carotid artery (carotis interna, v. cerebralis) is that branch of the common carotid which is distributed to the brain, and to the eye with its appendages. It extends from the place of bifurcation of the common carotid, usually in a straight direction, to the base of the skull, where it ascends in a winding course through the temporal bone, and after entering the cranial cavity, ends by the side of the anterior clinoid process of the sphenoid bone.
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The axillary artery, gives off several branches, which supply the neighbouring structures. They consist of the branches furnished to the muscles on the chest (external thoracic) ; a large branch to the shoulder (subscapular) ; and two to the upper part of the arm (anterior circumflex and posterior circumflex). The branches are not constant in their number, Size, or mode of origin.
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The external carotid artery gives origin to eight branches, including the two into which it finally divides. For the purposes of description these may be arranged into three sets. 1. Those which are directed forwards, viz., the superior thyroid, the lingual, and the facial. 2. Those which run backwards, — the occipital and posterior auricular; and 3, those which ascend, viz., the ascending pharyngeal branch with the temporal and internal maxillary, — the two terminal branches.
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The axillary artery [a. axillaris], that part of the artery of the upper limb which intervenes between the subclavian and the brachial portions, lies obliquely upon the upper and lateral part of the thorax, extending from the outer border of the first rib to the lower margin of the tendons of the latissimus dorsi and teres major muscles. In this course it passes through the axilla or axillary space, and its direction varies with the position of the limb : when the arm hangs freely by the side, the vessel describes a curve having its concavity towards the chest; when the arm is at right angles with the trunk, the vessel is nearly straight, and if the limb be still more elevated, the concavity of the curve described by the vessel is directed upwards.
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The external carotid artery (carotis superficialis s. externa, — Haller), is smaller than the internal carotid in young subjects, but about of equal size in the adult. It reaches in the neck from the point of division of the common carotid (opposite the upper margin of the thyroid cartilage) to the neck of the condyle of the lower jaw-bone, or a little lower, where it divides into two branches, the temporal and the internal maxillary. This artery diminishes rapidly in size as it ascends in the neck, owing to the number and size of the branches which spring from it.
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The three large branches which arise from the first part of the subclavian artery spring from the parent trunk very close to each other, and are deeply seated at their origin under cover of the internal jugular vein. They proceed, however, from different sides of the parent vessel, pursue different directions, and are distributed to remotely separate parts.
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The leading facts in the foregoing account of the common carotid artery will here be brought together in connection with the performance of an operation for tying the artery, as in a case of aneurism. — As this artery does not, save in very rare instances, furnish any branch, (in a practical or surgical point of view the branches sometimes found to arise close to its upper end may be disregarded,) a ligature can be applied to any part of the vessel except immediately at its commencement or termination.
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