The brachiocephalic veins, previously known as the innominate veins, are large paired valveless asymmetric central veins that drain the head, neck, upper limbs and part of the thorax and mediastinum.
Gross anatomy
Origin
In the root of the neck, the internal jugular (IJV) and subclavian veins unite to form the brachiocephalic veins posterior to the medial ends of the clavicles.
Course
The left brachiocephalic vein is approximately 6 cm long and runs a long, oblique course to the right through the superior mediastinum anterior to the branches of the aortic arch to unite with the right brachiocephalic vein posterior to the first sternocostal joint to form the superior vena cava.
The right brachiocephalic vein is much shorter, approximately 2.5 cm long and runs a vertical course anterior to the brachiocephalic trunk. It becomes the superior vena cava as it is joined from the left by the left brachiocephalic vein.
Tributaries
Right brachiocephalic vein
right vertebral vein
right inferior thyroid vein
right internal thoracic vein
right supreme intercostal vein
NB: on the right the superior intercostal vein usually drains into the azygos vein
Left brachiocephalic vein
left vertebral vein
Relations
anteriorly: pleura, upper lobes, thymus, manubrium, strap muscles (sternohyoid muscle, sternothyroid muscle)
posteriorly: aortic arch (left brachiocephalic vein), great vessels, the dome of the pleura, vagus nerve
Variant anatomy
retroesophageal and retrotracheal left brachiocephalic vein
double left brachiocephalic vein
absent left brachiocephalic vein with persistent left superior vena cava
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