Costocervical trunk

Origin and course

The costocervical trunk is a short artery that usually stems from the upper portion of the distal segment of the subclavian artery, distal to the thyrocervical trunk. The origin of the costocervical trunk is located at the level of the lower pole of the inferior (cervicothoracic/stellate) ganglion.

It courses posteriorly, over the apex of the lung, where it divides into two terminal branches; supreme intercostal and deep cervical arteries.

Branches and supply

After a short course in the neck, the costocervical trunk terminates by dividing into two terminal branches: the supreme intercostal artery and the deep cervical artery.

• The supreme intercostal artery (also known as the superior intercostal artery) arches posteroinferiorly, between the parietal pleura and neck of the first rib. It passes lateral to the stellate ganglion and medial to the anterior rami of spinal nerve T1. Descending down the inner aspect of the thoracic cage, it provides the first two posterior intercostal arteries for the first two intercostal spaces. The artery terminates by anastomosing with the third posterior intercostal artery. Here, it provides the blood supply for the muscles, skin and parietal pleura of the corresponding intercostal spaces.
• The deep cervical artery courses in a posterosuperior direction passing over the neck of the first rib. It then runs upwards, parallel to the cervical spine and over the posterior neck muscles. It terminates at the level of the second cervical vertebra where it forms an anastomosis with the descending branch of the occipital artery. At the proximal segment, the artery provides a spinal branch that enters the cervical spinal canal between the last cervical and first thoracic vertebrae. Distally, it gives off several muscular branches that supply the posterior muscles of the neck.

Learn more about the anterior neck vessels and nerves with our articles, videos, labeled diagrams and quizzes.

Anatomical variations

• In about 40% of cases, the costocervical trunk arises more proximally, at the second segment of the subclavian artery.
• In approximately 25% of cases there is an additional accessory deep cervical artery, more often on the left side.
• The superior intercostal artery is not constant, it can be absent and replaced by a direct branch from the descending aorta. This branch can also arise from other arteries such as the thyrocervical trunk, the deep cervical, inferior thyroid, second intercostal, or axillary arteries.