Ascending cervical artery

The ascending cervical artery (arteria cervicalis ascendens) is a small branch of the thyrocervical trunk, which itself arises from the first part of the subclavian artery, lateral to the vertebral artery and adjacent to the anterior scalene muscle.

Origin

The ascending cervical artery is one of the four branches of the thyrocervical trunk, alongside the inferior thyroid artery, the suprascapular artery, and the transverse cervical artery. It typically arises from the inferior thyroid artery or directly from the thyrocervical trunk itself.

Course

The artery ascends on the anterior aspect of the cervical spine, coursing along the medial border of the phrenic nerve and anterior to the transverse processes of the cervical vertebrae. It runs superficial to the prevertebral fascia overlying the longus coli muscles, ascending in the interval between the scalenus anterior and the longus capitis muscles.

Branches and Supply

The ascending cervical artery gives off muscular and spinal branches:

• Muscular branches supply the deep prevertebral muscles of the neck, including the longus coli, longus capitis, and the scalene muscles, as well as adjacent structures.

• Spinal branches enter the vertebral canal through the intervertebral foramina to supply the spinal cord, its meninges, and the vertebral bodies. These spinal branches may anastomose with branches of the vertebral artery and the anterior spinal artery.

• Nutrient branches pass over the longus coli muscles, forming a leash of vessels within the prevertebral fascia that extend in a frond-like pattern onto the anterior surface of the cervical vertebral bodies (C3–C7), providing their primary nutrient blood supply. The more cranial the cervical level, the fewer the number of nutrient vessels and foramina.

Anastomoses

The ascending cervical artery participates in important anastomotic connections. In the fetus, an anastomotic arterial chain ventral to the spinal column connects the thyrocervical trunk and the ascending cervical artery to the vertebral artery. In the adult, its spinal branches may anastomose with the anterior spinal artery — a connection of critical importance during embolization procedures through the thyrocervical trunk, as inadvertent occlusion of these anastomoses can result in spinal cord ischemia.

Clinical Significance

• During anterior cervical spine surgery, the ascending cervical artery and its nutrient branches are at risk, as they lie within the prevertebral fascia overlying the longus coli muscles — the surgical corridor for anterior approaches. Disruption of these vessels may contribute to anterior vertebral bone loss postoperatively.

• In interventional neuroradiology, the ascending cervical artery may serve as a route for preoperative embolization of cervical tumors (e.g., paragangliomas, vertebral metastases, aneurysmal bone cysts). Knowledge of its anastomoses with the anterior spinal artery is essential to avoid catastrophic spinal cord injury during embolization.

• The ascending cervical artery may also serve as a collateral pathway in cases of vertebral artery occlusion or subclavian steal syndrome.