The axillary artery, the continuation of the subclavian, commences at the outer border of the first rib, and ends at the lower border of the tendon of the Teres major, where it takes the name of brachial.
Its direction varies with the position of the limb; thus the vessel is nearly straight when the arm is directed at right angles with the trunk, concave upward when the arm is elevated above this, and convex upward and lateralward when the arm lies by the side. At its origin the artery is very deeply situated, but near its termination is superficial, being covered only by the skin and fascia.
To facilitate the description of the vessel it is divided into three portions; the first part lies above, the second behind, and the third below the Pectoralis minor:
- The first portion of the axillary artery is covered anteriorly by the clavicular portion of the Pectoralis major and the coracoclavicular fascia, and is crossed by the lateral anterior thoracic nerve, and the thoracoacromial and cephalic veins; posterior to it are the first intercostal space, the corresponding Intercostalis externus, the first and second digitations of the Serratus anterior, and the long thoracic and medial anterior thoracic nerves, and the medial cord of the brachial plexus; on its lateral side is the brachial plexus, from which it is separated by a little areolar tissue; on its medial, or thoracic side, is the axillary vein which overlaps the artery. It is enclosed, together with the axillary vein and the brachial plexus, in a fibrous sheath—the axillary sheath—continuous above with the deep cervical fascia.
- The second portion of the axillary artery is covered, anteriorly, by the Pectorales major and minor; posterior to it are the posterior cord of the brachial plexus, and some areolar tissue which intervenes between it and the Subscapularis; on the medial side is the axillary vein, separated from the artery by the medial cord of the brachial plexus and the medial anterior thoracic nerve; on the lateral side is the lateral cord of the brachial plexus. The brachial plexus thus surrounds the artery on three sides, and separates it from direct contact with the vein and adjacent muscles. 7
- The third portion of the axillary artery extends from the lower border of the Pectoralis minor to the lower border of the tendon of the Teres major. In front, it is covered by the lower part of the Pectoralis major above, but only by the integument and fascia below; behind, it is in relation with the lower part of the Subscapularis, and the tendons of the Latissimus dorsi and Teres major; on its lateral side is the Coracobrachialis, and on its medial or thoracic side, the axillary vein. The nerves of the brachial plexus bear the following relations to this part of the artery: on the lateral side are the lateral head and the trunk of the median, and the musculocutaneous for a short distance; on the medial side the ulnar (between the vein and artery) and medial brachial cutaneous (to the medial side of the vein); in front are the medial head of the median and the medial antibrachial cutaneous, and behind, the radial and axillary, the latter only as far as the lower border of the Subscapularis.
The branches are:
- First part (1 branch)
- Superior thoracic artery (Supreme thoracic artery)
- Second part (2 branches)
- Thoraco-acromial artery
- Lateral thoracic artery. If the lateral thoracic artery is not branching from the axillary artery, will most likely branch from the following (in order of likelihood): (1) thoracoacromial, (2) third part of axillary artery, (3) suprascapular artery, (4) subscapular artery
- Third part (3 branches)
- Subscapular artery
- Anterior humeral circumflex artery
- Posterior humeral circumflex artery