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The brachiocephalic artery, brachiocephalic trunk, or more commonly referred to clinically as the innominate artery, is one of the three great vessels of the aortic arch that supplies blood to the head, neck and upper extremities. Specifically, the artery goes on to form the right subclavian artery, which provides blood to the right upper extremity, and the right common carotid artery, which is one of the main arteries supplying blood to the head and neck. The innominate artery is of particular clinical significance not only due to its vital role in providing much of the blood to the superior aspect of the body but also due to anatomic variations that are numerous and not at all uncommon. These variations can often lead to malformations that may require surgical correction early on, primarily due to tracheal and/or esophageal compression. One of the more significant clinical circumstances involving the innominate artery is the formation of trachea-innominate artery fistulas in patients who have undergone tracheostomy, and are a leading cause of mortality after such procedures.