Brachiocephalic vein

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
• left inferior thyroid vein
• left internal thoracic vein
• left supreme intercostal vein
• left superior intercostal vein
• thymic veins
• pericardiophrenic veins

Relations

• anteriorly: pleura, upper lobes, thymus, manubrium
• posteriorly: aortic arch (left brachiocephalic vein), great vessels, the dome of the pleura

Variant anatomy

• retroaortic left brachiocephalic vein