Blood Supply of Limbs Flashcards
What are the branches of the aorta ? Which one is is the largest ?
- Brachiocephalic trunk (LARGEST, Wleading on to Right subclavian artery and Right common carotid)
- Left common carotid artery
- Left subclavian artery
Where does the brachiocephalic trunk bifurcate into R subclavian and R common carotid ?
Posterior to right Sternoclavicular joint
What do the R subclavian and R common carotid arteries supply respectively ?
R COMMON CAROTID:
• Supplies the right side of the head and neck, intracranial structures
R SUBCLAVIA:
• Supplies the right upper limb, intracranial structures
How many parts does the subclavian artery have ? Where is each part located ?
1st part: Between origin and medial border of anterior scalene muscle. Right recurrent laryngeal nerve wraps around it.
2nd part: Deep to anterior scalene muscle
3rd part: Between lateral border of anterior scalene muscle and the 1st rib. Anterior to brachial plexus and
posterior to subclavian vein
What are the branches of the subclavian artery ?
1) Vertebral artery
2) Thyrocervical trunk (Gives off suprascapular artery which crosses under clavicle to supraspinatus fossa then infraspinatus fossa)
3) Costocervical trunk
4) Internal thoracic artery
Where is the axillary artery found ?
In axillary fossa
How many parts does the axillary artery have ? Where is each part located ?
Three parts
1st part: proximal to Pectoralis minor
2nd part: behind Pectoralis minor
3rd part: distal to Pectoralis minor
What are the branches of the second part of the axillary artery ? What does each one supply ?
1) Lateral thoracic artery: Supplies breast, axillary lymph nodes and anterior wall of the thorax
2) Thoraco-acromial artery: Supplies the anterior wall of the axilla and thorax
What are the branches of the third part of the axillary artery ? Where does each pass ? What do all of these supply ?
1) Anterior circumflex humeral artery
2) Posterior circumflex humeral artery
• Passes through quadrangular space
• Forms an anastomosis around the surgical neck of the humerus
3) Subscapular artery:
• Anastomose with thyrocervical trunk
• 2 branches: Thoracodorsal artery, and Circumflex scapular artery whihch passes from superior triangular space to infraspinatus fossa
ALL SUPPLY POSTERIOR WALL OF AXILLA
Where does the brachial artery begin and where does it end ? What structures lie anterior, and on both sides of it ?
Begins at the lower border of teres major and ends in the cubital fossa
Lies anterior to triceps and between biceps and brachialis
What are the branches of the brachial artery ? Give the main features of these, especially where each one passes/possible anastomoses.
1) Profunda Brachii Artery: Passes through lower triangular space
• Travels with radial nerve in the radial (spiral) groove
• Terminates into medial & radial collaterals
2) Superior ulnar collateral artery: anastomoses with posterior ulnar recurrent artery
3) Inferior ulnar collateral artery: anastomoses with anterior ulnar recurrent artery
4) Radial artery
5) Ulnar artery
Identify peri-articular anastomoses of the arm and forearm.
1) Superior ulnar collateral artery anastomoses with posterior ulnar recurrent artery
2) Inferior ulnar collateral artery anastomoses with anterior ulnar recurrent artery
3) Radial collateral artery anastomoses with radial recurrent artery
Where does the radial artery begin and where do it end ?
Identify the structure which runs alongside the radial artery.
Runs laterally from the midpoint of the cubital fossa to just medial to the radial styloid process.
Radial nerve on lateral side.
How does the continuation of the radial artery enter the hand ?
Enters hand by curving dorsally around scaphoid and trapezium, crossing the anatomical snuff box
Which of radial or ulnar is larger ?
Ulnar
What are the branches of the ulnar artery ? What does each supply ?
1) Anterior and posterior ulnar recurrent arteries
2) Common interosseous artery, including:
• The Anterior interosseous artery
• The Posterior interosseous: Supplies all forearm extensors.
3) Unnamed branches: Supply medial forearm (deep forearm flexors and pronators).
Identify the structure which runs alongside the ulnar artery.
Ulnar nerve at medial side at distal forearm
How does the continuation of the ulnar artery enter the hand ?
Enters hand between two layers of flexor retinaculum, between the pisiform and hook of hamate
What is the arterial supply of the hand ?
2 Palmar arches
Where are the palmar arches located, relative to the palmar aponeurosis ?
Deep to the palmar aponeurosis
What are the names of the palmar arches ? What vessels are they a continuation of respectively ?
Superficial Palmar Arch (terminal branch of the ulnar artery)
Deep Palmar Arch (branch of radial artery)
What structure completes the superifical palmar arch ? What artery is this structure given off by ?
Radial artery gives off superficial palmar branch that completes the superficial palmar arch
What structure completes the deep palmar arch ? What artery is this structure given off by ?
Ulnar artery gives off deep palmar branch that completes the deep palmar arch
What are the continuations of the superifical palmar arch ?
COMMON PALMAR DIGITAL ARTERIES and then
PROPER PALMAR DIGITAL ARTERIES (2nd – 4th digits))
What are the continuations of the deep palmar arch ?
Palmar metacarpal arteries and then,
Proper palmar digital arteries (from superficial palmar arch)
What are the components of the dorsal carpal arch ?
Dorsal carpal branches (from radial and ulnar) + anterior and posterior interosseal branches
Identify peri-articular anastomoses of the hand.
Ulnar & radial arteries give off palmar & dorsal carpal branches forming peri-articular anastomoses around the wrist.
Name the vessels which emerge from the dorsal carpal arch.
Dorsal metacarpal and dorsal digital arteries
Name the superficial veins of the upper limbs. Identify their origin and any potential branches.
- Dorsal digital veins: join and form dorsal metacarpal veins
- Dorsal metacarpal veins: join and form dorsal venous network of the hand from which the superficial veins of the upper limb originate.
- Cephalic vein: originates from the lateral aspect of the venous network.
- Basilic vein: originates from the medial aspect of the venous network.
- Median cubital vein connects cephalic and basilic veins
- Median antebrachial vein
What are the different locations where a pulse can be left along the arm ?
- Mid shaft of humerus in medial bicipital groove (brachial)
- Cubital fossa (brachial)
- Wrist anterolateral surface (radial)
How, and where are the cephalic and basilic veins connected ?
At the elbow, the cephalic and basilic veins are connected by the median cubital vein
Describe where the brachial, and cephalic veins pass respectively, especially wrt surrounding structures.
Cephalic vein ascends along lateral border of the wrist and anterolateral surface of the forearm and arm. Then enters the clavipectoral triangle to join the axillary vein.
Basilic vein ascends along medial forearm and inferior arm, piercing brachial fascia to run parallel to brachial artery. Then opens into or merges with brachial vein to form axillary vein.
What areas does the median antebrachial vein drain, and where does it drain these ?
Drains the palm and anterior forearm into the basilica vein or median cubital vein
Name the deep veins of the upper limb.
Deep venous network drains superficial palmar venous arch
Vena comitantes accompany ulnar and radial arteries
Where do deep veins drain into ?
Deep veins drain into brachial vein, then axillary vein
What is the name of the vessels connecting deep and superficial veins ?
Perforating veins
What is the axillary vein a continuation of ?
Continuation of the basilic vein and the deep veins that accompany the brachial artery, but also receives the cephalic vein (cephalic vein joins axillary vein).
Where is the axillary vein located ? Where does it end/which vein does it become ?
Lies medial to the axillary artery and begins at the lower margin of teres major.
Ends at the 1st rib to become the subclavian vein
Where is the subclavian vein (continuation of axillary vein) located ?
Lies anterior to the subclavian artery
What are the branches of the abdominal aorta ? Where does the branching taking place ?
Left and right common Iliac arteries
At the sacroiliac joint
What are the branches of the L and R common iliac arteries ? What do these supply ?
Internal and External (R and L) Iliac Arteries
External and Internal Iliac arteries supply lower limb and pelvic regions, with the external iliac supplying the majority of the lower limb.
Under which structure does the external iliac artery pass ?
Under the inguinal ligament
What are the branches of the external iliac artery ? What do these supply ?
Femoral artery and profunda femoris artery
They (or their branches) supply the hip joint, thighs, legs and feet.
How do the internal iliac arteries enter the gluteal region ?
Via the greater sciatic foramen above and below piriformis.
What do the internal iliac arteries supply ?
- Supply the gluteal musculature
- Take part in anastomoses around the hip joint (especially gluteal vessels): these anastomoses are the origin of the blood supply to the femoral head + provide collateral circulation to the lower limb should the external iliac and/or femoral be obstructed
What are the branches of the internal iliac arteries ?
Superior Gluteal Artery
Inferior Gluteal Arteries,
Internal Pudendal
Obturator Artery
Describe the path of the femoral artery (branch of the external iliac artery).
Enters femoral triangle through the retro- inguinal space, at the mid-inguinal point. Then enters Adductor canal to pass into the popliteal fossa and continues as popliteal artery
What are the branches of the femoral artery ?
- Superficial epigastric artery
- Superficial circumflex iliac
- External pudendal arteries
- Profunda femoris
What is the continuation of the femoral artery ? Where does the change from femoral artery to this artery occur ?
Popliteal artery
Femoral artery enters Adductor canal to pass into the popliteal fossa and continues as popliteal artery
Describe the path of the PROFUNDA FEMORIS ARTERY What does it supply ?
Arises from the lateral aspect of the femoral and passes postero-medially between the adductors to run inferiorly between adductor longus and magnus, supplying the THIGH MUSCULATURE.
What are the branches of the profunda femoris artery ?
- Medial circumflex femoral artery
- Lateral circumflex femoral artery
- 3-4 perforators.
Where does the Adductor Canal begin and end ?
Starts at the inferior corner of the femoral triangle
Ends with adductor hiatus
What are the contents of the adductor canal ?
- Saphenus nerve (pierces lamina vastoadductoria and becomes superficial)
- Femoral vessels
How do the femoral vessels exit the adductor canal ?
The femoral vessels exit through adductor hiatus
What are other names for adductor canal ?
Hunter’s or Subsartorial canal
What are the boundaries of the adductor canal ?
- Vastus medialis (anteriorly and laterally)
- Adductor longus and adductor magnus (posteriorly)
- Sartorius and lamina vastoadductoria (medially)
Where is the obturator artery located ?
Lies on lateral wall of pelvis, passing through obturator canal
Which artery of the lower limb can be involved in tumour of the ovaries ? Which symptom can be felt as a result ?
Obturator Artery
Referred pain to medial thigh
What is the blood supply to the femoral head ?
Medial and Lateral Circumflex Femoral Arteries
Obturator Artery
What possible event could impact blood supply to the femoral head ? Why
Fracture of the femoral neck
Because there are reticular vessels passing on the neck to the head
Why is it difficult to obtain a pulse in the popliteal artery ?
Because it is the deepest structure in the popliteal fossa
Where is the popliteal artery located ?
Between Hiatus tendineus and lower border of popliteus muscle
What are the branches and continuation of the popliteal artery ?
- 5 genicular branches
- Ends as the posterior and anterior tibial
arteries
What does the popliteal artery supply ?
Supply hamstring, gastrocnemius, soleus and plantaris muscles and the knee joint.
What is the clinical significance of the popliteal artery ?
- Second most common site of aneurysm
- May be compromised in dislocation of the knee and fractures of the lower femur
What vessels form the genicular anastomosis ? Where is this genicular anastomosis found ?
- 4 genicular arteries
- branches of the femoral
- branches of the profunda femoris
- a branch from anterior tibial artery
AROUND THE KNEE JOINT
Where does anterior tibial artery pass ? What does it supply ?
Passes anteriorly superior to the interosseal membrane, then descends between the tibialis anterior and extensor digitorum longus.
Supplies the muscles in the anterior compartment of the leg (dorsiflexors).
What is the continuation of the anterior tibial artery ? Where does the change from anterior tibial artery to (continuation) artery occur ?
At ankle, it becomes the dorsalis pedis artery.
Where does the posterior tibial artery pass ? What does it supply ?
-Accompanies the tibial nerve as it descends deep to the soleus muscle.
Supplies the muscles of the posterior compartment of the leg (plantar flexors).
What are the branches of the posterior tibial artery ? What is the continuation of the posterior tibial artery, where does this change from the posterior tibial artery occur ?
Fibular artery, Circumflex fibular and Nutrient arteries
Becomes the medial and lateral plantar arteries after running posterior to the medial malleolus
Where can the posterior tibial artery pulse be felt ?
Pulse can be taken behind the medial malleolus
What are the branches of the dorsalis pedis artery ? What structures does the dorsalis pedis artery, along with its branches, supply ?
Lateral tarsal, deep plantar, arcuate, 1st dorsal metatarsal
These branches give rise to dorsal digital arteries of the phalanges
The dorsum of the foot
Where is Dorsalis pedis pulse taken ?
In the first metatarsal space, between the EDL and EHL tendons
What are the arteries of the sole of the foot ?
Plantar Medialis and Lateralis Arteries
What are the branches of the plantar medialis and lateralis arteries? What structures do the plantaris medialis and lateralis arteries, along with their branches, supply ?
Superficial (branch of the medial plantar artery) and deep (branch of the lateral plantar artery) plantar arches.
These deep arch gives rise to plantar digital arteries of the phalanges.
Supply the sole of the foot
What are the superficial veins of the lower limb ?
Great saphenous vein
Small saphenous vein
What is the origin of the superficial veins of the lower limb ?
Originate from the dorsal venous arch of the foot and dorsal veins of foot
Describe the path of the great saphenous vein and small saphenous vein respectively.
GREAT SAPHENOUS VEIN:
Ascends 2.5 cm anterior to the medial malleolus, posterior to medial condyle of femur (Hands breadth behind the patella).
Pierces the fascia lata to join the femoral vein.
SMALL SAPHENOUS VEIN:
Ascends posterior to lateral malleolus and penetrates the deep fascia of the leg between the heads of the gastrocnemius muscle.
Merges with deep veins to form the popliteal vein
What are the deep veins of the lower limb ?
-Paired veins travelling with the arteries of the same name, within vascular sheaths with the artery:
Femoral vein (receiving drainage from profunda femoris, great saphenous and other small branches) ascends the adductor canal from the popliteal vein, it enters the femoral sheath and ends as the external iliac vein.
Where are the deep veins of the lower limb located ?
Ascend internal to the deep fascia of the lower limb
Does veinous blood flow superficial to deep or deep to superficial ? How ?
Superficial to deep, via perforators
What are some factors which aid veinous flow in the lower limbs ?
- Muscle pump, arterial pulsation and negative intrathoracic pressure all help venous return to the heart, against gravity.
- Valves prevent backflow
What does the obturator artery and its branches supply ?
- Supply head of acetabulum (post branch), hip adductors, knee, and skin of medial thigh
- Anastomoses with branches from profunda femoris
