Anatomy, Head and Neck, Costocervical Trunk Arteries

The superior intercostal artery, which branches off the costocervical trunk, supplies the upper intercostal spaces. It passes inferiorly between the pleura and the necks of the first and second ribs, where it divides into two posterior intercostal arteries. The upper two intercostal muscles receive vascular supply from the superior intercostal artery and its branches. The deep cervical artery, which is another branch of the costocervical trunk, passes inferiorly above the eight cervical spinal nerve between the transverse process of the seventh cranial vertebra. From there, it ascends to the deep muscles of the neck and the back. It gives off muscular branches to supply the deep muscles in the neck and upper back.[16][17][18][12][19][20]

Although the costocervical trunk commonly originates from the second part of the subclavian artery, it can originate from its third part or be absent en bloc. The two usual branches of the costocervical trunk include the deep cervical artery and the superior intercostal artery, which can arise independently from the subclavian artery if the trunk is absent. The superior intercostal artery can originate from the thyrocervical trunk or some of its branches like the inferior thyroid artery and the scapular artery. There are also reports that the superior intercostal artery can originate from the axillary artery, aortic arch, vertebral artery, or the second intercostal artery[21][22][23][24][25][26][27]

Costocervical trunk Pseudoaneurysms

Costocervical trunk pseudoaneurysms are extremely rare. They can be the result of bullectomy with pleural abrasion, blind cannulation of the jugular vein, secondary to infection like in the case of pulmonary tuberculosis, atherosclerosis of the costocervical trunk, trauma to the neck, or certain vasculitides (e.g., Takayasu arteritis).[28] Chest pain is a prevalent complaint in patients with costocervical trunk pseudoaneurysm. In rare cases, it can present with hemoptysis.[29] In the case of pseudoaneurysm rupturing, it can present as an expanding mass in the neck. The mass can affect the airways leading to labored breathing.[30][31] The gold standard method for diagnosing costocervical trunk aneurysms is CT angiography. Transcatheter embolization can be used for the management of ruptured costocervical trunk pseudoaneurysms.[30][32]

Takayasu arteritis

Takayasu arteritis, which can go by many other names like occlusive thromboaortopathy, pulseless disease, and Martorell syndrome, is inflammatory arteritis of the large blood vessels that involves the aorta and its major branches including the subclavian artery and the costocervical trunk. The condition can be detected clinically by the presence of bruits in the upper lateral anterior thorax or lower neck and the absence of a radial pulse. It can be accompanied by ischemic changes that involve the upper extremities and head and neck. The arteries supplying blood to the brain can undergo degenerative changes or form aneurysms that could eventually result in strokes. The reported presence of hypertension was in 33 to 83% of patients, Diminished or absent pulses in 84 to 96%, Takayasu retinopathy 37%.[33][34][35][36]

Perforation of the costocervical trunk

A transradial arterial approach to coronary angiography is associated with decreased vascular complications compared to a transfemoral arterial approach. It also allows for the early mobilization of patients. However, in rare cases, perforation of the costocervical trunk can take place shortly after a percutaneous transradial coronary intervention, which can result in a rapidly expanding cervical hematoma that presses on the airway and cause several breathing problems. This condition requires emergency intubation to preserve the patency of the airways.[37]

Collateral circulation

The first and second intercostal spaces are typically supplied with blood by the superior intercostal artery, which is of great clinical importance if the anterior intercostal or internal thoracic arteries become compromised. Moreover, the superior intercostal artery may supply blood to the descending aorta in the case of coarctation of the aorta through mediastinal collateral branches that bypass the coarctation.[10][7] It is a clinical observation that the mediastinal collateral arteries become hypertrophied in patients with obstruction of the subclavian artery or coarctation of the aorta. The mediastinal arteries play an important role in such instances as they connect the costocervical trunk, superior intercostal artery, or subclavian artery to the descending thoracic aorta bypassing the narrowed portion of the aorta.[10] In the case of occlusion of the internal carotid artery, blood can divert through several collateral arteries, including the occipital artery, vertebral artery, costocervical trunk, deep cervical artery, and thyrocervical trunk.[38] Aneurysm of the superior intercostal artery can be the result of the coarctation of the aorta or neurofibromatosis type 1. Selective endovascular embolization combing glue and micro-coils is the treatment of choice for superior intercostal artery aneurysms. Embolization of the superior intercostal artery is well-tolerated because the intercostal spaces supplied by it receive collateral arterial circulation from the anterior intercostal arteries.[39][40][7]