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Circumflex scapular artery

The circumflex scapular artery is a major terminal branch of the subscapular artery, originating within the axilla and providing essential blood supply to the posterior shoulder and scapular region.^[1]^[2]^[3] It arises from the subscapular artery, which itself branches from the third part of the axillary artery, typically 4–6 cm distal to the axillary artery's origin.^[2]^[3] From its origin, the artery travels posteriorly through the triangular space—bounded superiorly by the teres minor muscle, inferiorly by the teres major muscle, and laterally by the long head of the triceps brachii—before curving around the lateral border of the scapula to enter the infraspinous fossa.^[1]^[2]^[3] Along its course, the circumflex scapular artery gives rise to several branches, including muscular branches to the teres major, teres minor, infraspinatus, posterior deltoid, and long head of the triceps brachii muscles, as well as cutaneous branches supplying the skin over the spine and lateral border of the scapula.^[2]^[3] It also provides articular branches to the glenoid labrum and glenohumeral joint capsule, and terminates by dividing into superficial and deep branches that anastomose with the suprascapular artery superiorly and the dorsal scapular artery inferiorly, forming part of the scapular anastomosis network.^[1]^[2] This arterial supply is clinically significant in shoulder surgeries, trauma management, and reconstructive procedures, such as the scapular flap, where preservation of the circumflex scapular artery ensures adequate perfusion to the scapular region and collateral circulation around the shoulder girdle.^[2]^[3]

Structure

Origin

The circumflex scapular artery arises as the larger terminal branch of the subscapular artery, which originates from the third part of the axillary artery opposite the lower border of the subscapularis muscle.^[4] This artery emerges from the posterior aspect of the subscapular artery at the level of the axillary border of the scapula, marking the precise point of its divergence within the axilla.^[2]^[1] From its origin, the circumflex scapular artery initially travels dorsally and laterally, directing posteriorly relative to the shoulder joint to begin its path toward the scapular region.^[1]^[2]

Course

The circumflex scapular artery emerges from the subscapular artery and passes posteriorly through the triangular space (also termed the triangular interval), a passageway bounded superiorly by the teres minor muscle, inferiorly by the teres major muscle, and laterally by the long head of the triceps brachii muscle.^[5] This trajectory allows the artery to exit the axilla and access the posterior shoulder region.^[1] Upon traversing the triangular space, the artery curves around the lateral (axillary) border of the scapula, transitioning to its posterior aspect.^[6] It then enters the infraspinous fossa deep to the teres minor muscle, positioning itself beneath the overlying rotator cuff structures.^[3] Within the infraspinous fossa, the artery travels superomedially along the dorsal surface of the scapula, following the contour of the bone toward the scapular neck.^[7] This path facilitates its role in the vascular network of the posterior scapular region.^[1]

Branches

The circumflex scapular artery divides into two main branches shortly after emerging from the triangular space: a superficial (descending) branch and a deep (ascending) branch.^[1]^[2] The superficial branch courses inferiorly along the lateral border of the scapula between the teres major and teres minor muscles, giving rise to cutaneous branches such as the horizontal branch over the scapular spine and the parascapular branch along the border, while supplying adjacent muscles.^[1]^[8] The deep branch passes superiorly and medially, entering the infraspinous fossa beneath the teres minor muscle to anastomose with other scapular vessels.^[1]^[2] In addition, the circumflex scapular artery gives off minor branches, including small twigs to the posterior aspect of the deltoid muscle and the long head of the triceps brachii.^[3]^[8]

Anastomoses

The circumflex scapular artery plays a central role in the scapular anastomosis, also referred to as the circumscapular anastomosis, which establishes a robust collateral vascular network encircling the scapula to facilitate alternative blood flow in cases of arterial occlusion.^[9] This network integrates branches from both the subclavian and axillary arteries, ensuring redundancy in the shoulder region's perfusion.^[10] Within the infraspinous fossa, the deep branch of the circumflex scapular artery forms a direct anastomosis with the suprascapular artery (also known as the transverse scapular artery), contributing to the posterior aspect of the scapular network.^[2] Additionally, along the medial border of the scapula, it anastomoses with the dorsal scapular artery, which arises as the descending branch of the transverse cervical artery, thereby linking the supra- and infrascapular circulations.^[1] The circumflex scapular artery also establishes supplementary connections with the posterior humeral circumflex artery, extending the anastomosis laterally toward the humeral head, and with branches of the posterior intercostal arteries medially, further bolstering the collateral pathways around the scapula.^[10]^[9] These interconnections underscore the artery's contribution to the dynamic vascular architecture supporting scapular mobility.^[11]

Supply

Muscles

The circumflex scapular artery provides primary vascular supply to several muscles in the posterior shoulder region, particularly through its muscular branches that arise along its course after passing through the triangular space. These branches deliver oxygenated blood essential for the metabolic demands of these rotator cuff and adjacent muscles during shoulder movement and stabilization.^[2] The teres minor muscle receives direct perfusion from the circumflex scapular artery via its deep branch, which courses through the muscle within the infraspinous fossa, ensuring robust blood flow to support its role in external rotation and humeral head stabilization.^[12] Additionally, the artery's path adjacent to the teres minor facilitates this targeted supply.^[2] The teres major muscle is supplied by branches of the circumflex scapular artery emanating near the triangular space, where the vessel emerges between the teres major inferiorly and the subscapularis and teres minor superiorly, providing nourishment to its fibers involved in arm adduction and internal rotation.^[3] Perfusion to the infraspinatus muscle occurs primarily through the deep branch of the circumflex scapular artery, which enters the infraspinous fossa and anastomoses within the muscle belly, contributing significantly to its blood supply in up to 81% of cases and aiding its function in external rotation.^[3]^[13] The subscapularis muscle is supplied by branches from the circumflex scapular artery, in addition to the subscapular and suprascapular arteries, supporting the muscle's internal rotation and anterior stability of the glenohumeral joint.^[14] Minor twigs from the circumflex scapular artery extend to the posterior fibers of the deltoid muscle and the long head of the triceps brachii, providing supplementary vascularization near the axillary region to facilitate their roles in arm extension and abduction.^[3] These contributions enhance redundancy in muscle blood supply via participation in the scapular anastomosis network.^[11]

Other structures

The circumflex scapular artery provides essential perfusion to various non-muscular structures in the scapular region, complementing its primary role in supplying surrounding muscles. Nutrient branches arise from the artery to nourish the scapula bone, particularly along its lateral border, entering the infraspinous and subscapular fossae to support bone growth and maintenance.^[15]^[16] This artery also contributes significantly to the vascular supply of the shoulder joint capsule, forming part of the articular vascular arcade through consistent arterial branches that provide centripetal blood flow and intracapsular anastomoses via horizontal dominant vessels.^[17] Superficial perforators from the circumflex scapular artery extend to the skin and subcutaneous tissues overlying the scapular region, arborizing into the subdermal plexus to ensure adequate cutaneous nutrition, often forming vascular arcades with adjacent perforators.^[18]

Clinical significance

Surgical applications

The circumflex scapular artery serves as a key vessel within the subscapular arterial system, providing the primary pedicle for scapular and parascapular flaps in reconstructive surgery, particularly for head and neck defects following tumor resection or trauma.^[19] These flaps leverage the artery's robust perforators to supply fasciocutaneous or osteocutaneous tissue, enabling coverage of complex contours in mandibular or midface reconstruction.^[20] In breast reconstruction, the artery contributes to the subscapular system's utility when combined with latissimus dorsi flaps, where the thoracodorsal branch is the main pedicle but the circumflex scapular branch may be preserved or utilized for chimeric designs to enhance vascular reliability.^[21] Recent advancements as of 2025 include refinements in the circumflex scapular artery perforator (CSAP) flap for soft tissue defects in various regions, offering improved customization and reduced donor site morbidity.^[22] Additionally, a free-style perforator-based stepladder flap utilizing CSA perforators has been described for extremity reconstruction, providing versatile options in clinical settings.^[23] The inframammary extended circumflex scapular (IMECS) flap has emerged as a reliable option for axillary reconstruction following hidradenitis suppurativa excision.^[24] The artery's suitability as a pedicle for free flaps stems from its extended course around the lateral scapular border and its large caliber, typically measuring 2-4 mm in diameter, which facilitates microsurgical anastomosis with minimal risk of thrombosis.^[25] This anatomical advantage allows for a wide arc of rotation and long pedicle length (up to 10-15 cm when traced proximally), making it ideal for distant recipient sites in head and neck or thoracic procedures.^[26] The first clinical application of the scapular flap based on this artery was described by dos Santos in the early 1980s, initially for mandibular reconstruction, marking a seminal advancement in free tissue transfer techniques.^[27] Preservation of the circumflex scapular artery is essential during shoulder surgeries, such as rotator cuff repairs, to maintain perfusion to the subscapularis and teres major muscles and prevent postoperative ischemia or deltoid dysfunction.^[28] Surgical approaches must avoid ligation of this vessel, as it forms part of the rotator cuff's extrinsic blood supply alongside the subscapular and posterior humeral circumflex arteries, ensuring hemodynamic stability in the posterior shoulder girdle.^[29]

Anatomical variations

The circumflex scapular artery (CSA) exhibits several documented variations in its origin, primarily involving deviations from its typical emergence as a branch of the subscapular artery, which arises from the third part of the axillary artery. In a radiographic analysis of 200 arterial systems, the subscapular artery was absent in 12.5% of cases (25/200), with the CSA arising directly from the axillary artery in 23 of those instances (11.5% overall incidence); this variant was associated with a larger mean CSA diameter of 2.45 mm compared to 1.94 mm in typical cases (p=0.004).^[30] A rarer origin, observed in 0.5% of the same cohort (1/200), involved the CSA emerging from the posterior circumflex humeral artery.^[30] Cadaveric studies corroborate these findings, reporting direct axillary origin of the CSA (often alongside the thoracodorsal artery) in 18.75% of 16 dissected upper limbs.^[31] Shared origins with adjacent vessels also occur. In a morphologic examination of 100 specimens, the CSA arose from a common trunk with the posterior humeral circumflex artery (originating from the subscapular artery) in 3% of cases (3/100), while a trifurcating trunk involving the CSA, posterior humeral circumflex artery, and thoracodorsal artery was noted in 6% (6/100).^[32] These origin variants double the classically estimated 5% incidence of direct axillary emergence in some modern imaging-based assessments.^[30] As of 2025, additional rare combined variations have been reported, including cases where the CSA and thoracodorsal artery arise from a separate common trunk directly from the axillary artery, highlighting the need for preoperative imaging in surgical planning.^[33] Course anomalies of the CSA are infrequent but can include entrapment within the subscapular system. A reported case documented compression of the proximal subscapular artery (from which the CSA branches) between the radial nerve and humerus, potentially altering downstream flow to the CSA and increasing vulnerability to ischemic complications during arm abduction.^[34] Altered paths through the triangular space (foramen omoclaviculare inferius), such as aberrant branching or kinking, have been noted in isolated cadaveric dissections, though population-level incidence remains undocumented.^[35] Branching differences encompass absence or hypoplasia of the CSA, typically linked to subscapular artery variants. In scenarios of absent subscapular artery (1.7-12.5% incidence across studies), the CSA may be hypoplastic or redirected via compensatory branches from the lateral thoracic artery (observed in 2.5% of cases).^[36]^[30] Conversely, hyperdevelopment of the CSA occurs in collateral circulation scenarios, such as axillary artery occlusion, where it enlarges to supply scapular anastomoses, as evidenced in angiographic reviews of occlusive disease.^[35] These variations hold clinical relevance for procedures involving the axillary region, as they may elevate bleeding risks during lymph node dissections or compromise pedicle reliability in scapular free-flap harvests; preoperative imaging is recommended to map atypical origins and mitigate intraoperative surprises.^[30]

References

[1]
Circumflex Scapular Artery - Course - Supply - TeachMeAnatomy
The circumflex scapular artery is an artery of the upper back. It contributes to the blood supply of structures within the scapular region of the back.
[2]
Circumflex scapular artery: Anatomy, branches, supply - Kenhub
The circumflex scapular artery is the largest terminal branch of the subscapular artery. It courses through the posterior aspect of the shoulder.
[3]
Circumflex Scapular Artery | Complete Anatomy - Elsevier
The circumflex scapular artery gives muscular branches to the teres major, infraspinatus, posterior deltoid, and the long head of the triceps brachii muscles.
[4]
Subscapular artery
### Summary of Subscapular Artery Origin
[5]
Quadrangular Space, Triangular Space, Triangular Interval - Anatomy
Dec 14, 2021 · Three important spaces of the shoulder that are bordered by the triceps include ... scapular circumflex artery. Triangular Interval. Borders.
[6]
Circumflex Scapular Artery - an overview | ScienceDirect Topics
The circumflex scapular artery (CSA) is defined as an artery that originates from the subscapular artery along the lateral border of the scapula, ...
[7]
Anatomy, Shoulder and Upper Limb, Infraspinatus Muscle - NCBI - NIH
The subscapular artery, a branch of the third portion of the axillary artery, gives rise to the circumflex scapular artery. The circumflex scapular artery ...Anatomy, Shoulder And Upper... · Structure And Function · Blood Supply And Lymphatics
[8]
Circumflex scapular artery - e-Anatomy - IMAIOS
In its course it gives off two branches: one (infrascapular) enters the subscapular fossa beneath the Subscapularis, which it supplies, anastomosing with the ...
[9]
Anatomy, Back, Scapula - StatPearls - NCBI Bookshelf - NIH
Contributory arteries to this anastomosis are the dorsal scapular artery, the suprascapular artery, the deep scapular artery, the circumflex scapular branch ...
[10]
Scapular anastomosis | Radiology Reference Article
Nov 9, 2016 · The pectoral girdle has a rich plexus of arterial vessels that anastomose around the scapula and its muscles known as the scapular anastomosis.
[11]
Arterial anastomoses of the upper extremity: Anatomy - Kenhub
While the circumflex scapular artery and infraspinous branch of the suprascapular artery anastomose with each other, they also join with branches of the ...
[12]
Anatomy, Shoulder and Upper Limb, Arm Teres Minor Muscle - NCBI
The teres minor is deep ... infraspinatus fossa where it joins the scapular anastomosis. Along its route, the circumflex scapular artery supplies the teres minor.
[13]
[PDF] Arterial Supply to the Rotator Cuff Muscles
In nine specimens the circumflex scapular artery supplied the subscapularis muscle n= 9/100 (9%) (right 5/50; left 4/50) (Table I). The subscapularis muscle ...<|control11|><|separator|>
[14]
A Detailed Analysis of the Blood Supply to the Subscapularis Muscle
The SSC muscle was generally supplied by branches from the subclavian artery (suprascapular artery, supraSA; circumflex scapular artery, CxSA; and dorsal ...
[15]
The Scapula Bone Flap - Microsurgeon.Org
The arterial branches to the lateral scapula originate on the circumflex scapular artery or the subscapular artery and sprout to the lateral edge of the scapula ...
[16]
Circumflex scapular artery – Knowledge and References
Circumflex scapular artery: Arises from the subscapular artery and reaches the muscles on the dorsum of the scapula after curving around the axillary border of ...
[17]
The vascular anatomy of the glenohumeral capsule and ligaments
Results: The glenohumeral capsule demonstrates consistent arterial contributions from the anterior circumflex, posterior circumflex, circumflex scapular, and ...Missing: arcade | Show results with:arcade
[18]
Scapular and Parascapular Flaps - Plastic Surgery Key
Mar 3, 2019 · The skin and subcutaneous tissue of the back may be harvested as a flap supplied by the cutaneous or superficial branch of the circumflex scapular artery.
[19]
The triangular intermuscular space as a site of lymph node ...
Through this space pass the descending circumflex scapular artery, vena comitants, and lymphatics. We report 3 patients with truncal melanoma, presenting ...
[20]
Circumflex Scapular Artery Perforator Flap and Its Surgical ...
Jan 16, 2025 · This study presents the circumflex scapular artery perforator (CSAP) flap and its surgical refinements for addressing soft tissue defects in various regions of ...
[21]
The free scapular/parascapular flap as a reliable method of ...
The anatomy of the flap was extensively described in 1980 by dos Santos (dos Santos, 1980, dos Santos, 1984), while in 1982 Nassif et al. (1982) published ...
[22]
Latissimus Dorsi Flap - StatPearls - NCBI Bookshelf
Apr 1, 2024 · The latissimus dorsi flap is a highly versatile reconstructive option used in head, neck, torso, and breast reconstruction surgeries.
[23]
The Scapular Flap - Microsurgeon.Org
The circumflex scapular artery is a branch of the subscapular artery which takes origin off the axillary artery. The circumflex scapular arises about 1 to 4 ...
[24]
Guidance for Circumflex Scapular Artery Flap Utilization in Pediatric ...
Dec 1, 2024 · The circumflex scapular artery (CSA) flap system, consisting of scapular, parascapular, and chimeric flaps, is useful for pediatric reconstruction in many ...
[25]
Scapular Free Flap | Pocket Dentistry
Jun 4, 2016 · History of the Procedure. First described by dos Santos in 1980, the scapular flap, along with the subscapular artery system upon which it is ...
[26]
Tendon transfers for irreparable rotator cuff tears - PMC - NIH
Its vascular supply is derived from the circumflex scapular artery, a branch of the subscapular artery and its nerve supply is from the lower subscapular ...
[27]
Arterial Supply to the Rotator Cuff Muscles - ResearchGate
Aug 7, 2025 · The arterial supply to the rotator cuff muscles is generally provided by the subscapular, circumflex scapular, posterior circumflex humeral ...
[28]
Anatomic variants of the subscapular-thoracodorsal arterial system
Jan 5, 2022 · Out of 200 arterial systems, 25 (12.5%) were lacking a subscapular artery, with the thoracodoral and circumflex scapular arteries arising ...
[29]
Anatomy of Y-shaped configurations in the subscapular arterial ...
A significant anatomical variation (i.e., both the thoracodorsal and circumflex scapular artery arose directly from the axillary artery) was found in three of ...
[30]
[PDF] Arterial Variations of the Subclavian-Axillary Arterial Tree
ACH= Anterior circumflex humeral artery; CS= Circumflex scapular artery; DSA ... Gray's Anatomy: The Anatomical Basis of Clinical. Practice. 40th ed ...
[31]
Entrapment of the Subscapular Artery between the Radial Nerve ...
This case report depicts a rare variant of compression and the kinking of the subscapular artery by the radial nerve on the posterior wall of the axilla.
[32]
Variations of the circumflex humeral arteries: a cadaveric study
Aug 7, 2025 · ... circumflex scapular artery) is seen in 11.3 ... [Show full abstract] anastomoses with a branch of the posterior humeral circumflex artery.
[33]
An Absent Subscapular Artery Co-Existing with Multiple Variants o
When the SSA was absent (1.7%), the circumflex scapular artery arose ... direct origin from the axillary artery. Huelke reported a 1.7% incidence of ...