From the Research
The sympathetic chain is located posterior to the internal mammary artery, anterior to the vertebral column, and has a variable relationship with the phrenic nerve, while the vagus nerve runs anterolaterally, and the azygous vein lies medial to the right sympathetic chain in the posterior mediastinum. The sympathetic chain runs parallel to the vertebral column on both sides, with its exact position relative to other structures being crucial for surgical procedures. According to the most recent and highest quality study 1, the upper thoracic sympathetic chain exhibits anatomical variations, including the presence of the cervicothoracic ganglion and nerve of Kuntz, which are important to consider during sympathectomies. The phrenic nerve's relationship to the internal mammary artery is variable, as shown in a study from 2, emphasizing the need for caution during dissection. The vagus nerve's course alongside the carotid artery and through the thoracic cavity positions it anterolaterally to the sympathetic chain. The azygous vein's location medial to the right sympathetic chain in the posterior mediastinum is significant for procedures in this area. Understanding these relationships is vital for preventing injury to these structures during thoracic surgeries, as highlighted in studies such as 3 and 4, which discuss the implications for cardiac interventionalists and the outcomes of limited thoracic sympathectomy for palmar hyperhidrosis, respectively. Key points to consider include:
- The sympathetic chain's posterior position to the internal mammary artery
- The variable relationship between the phrenic nerve and the internal mammary artery
- The vagus nerve's anterolateral course
- The azygous vein's medial position to the right sympathetic chain
- The importance of anatomical knowledge for surgical procedures to prevent injury to these structures.