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MSS > MSS18 Vascular Supply Of The Limbs > Flashcards

MSS18 Vascular Supply Of The Limbs Flashcards

1
Q

Main arteries of upper limb

A
  1. Subclavian artery
  2. Axillary artery
  3. Brachial artery
  4. Deep Brachial artery
  5. Ulnar artery
  6. Radial artery
  7. Superficial and Deep palmar arches
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2
Q

Blood flow of upper limb main arteries

A 
Subclavian
—> Axillary
—> Brachial + Deep Brachial
—> Ulnar + Radial
—> Deep + Superficial palmar arches
—> Digital
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3
Q

Subclavian artery

A

Left subclavian artery:
Arise directly from Aortic arch

**Right subclavian artery:
Branch of **Brachiocephalic trunk

Pulse:
- palpated posterior to midpoint of clavicle where artery passes over 1st rib

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4
Q

***Axillary artery

A

Supply: Pectoral, Scapular, Shoulder region

Location:

  • direct continuation of Subclavian artery
  • Axilla
  • Begins: lateral border of 1st rib
  • Ends: lower border of Teres major
  • Subdivided into 3 parts: Pectoralis minor

1st part:
- Superior thoracic artery

2nd part (brachial plexus cord region):
- Thoracoacromial artery
—> pectoral branch
—> deltoid branch
—> acromial branch
—> clavicular branch
  • Lateral thoracic artery

3rd part:
- Subscapular artery
—> Circumflex scapular artery (Triangular space)
—> thoracodorsal artery

  • Anterior circumflex humeral artery (encircle humerus surgical neck)
  • Posterior Circumflex humeral artery (encircle humerus surgical neck) (Quadrangular space)
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5
Q

Scapular anastomosis

A

Anastomosis around both surfaces of Scapula —> alternative route of blood supply to upper limb

Contributed by:

  1. Branches of 1st part of Subclavian artery —> Thyrocervical trunk —> **Dorsal scapular artery + **Suprascapular artery
  2. Branches of 3rd part of Axillary artery —> ***Circumflex scapular artery (Triangular space)
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6
Q

Brachial artery

A

Supply: ***Anterior arm

Location:

  • direct continuation of axillary artery
  • ends just distal to elbow
  • most common site of BP measurement
  • crossed by ***Median nerve from lateral to medial side

Pulse:

  • in ***Cubital fossa (front of elbow)
  • ***medial to Biceps brachii tendon
  • ***deep to Bicipital aponeurosis

Cubital fossa boundary: Pronator teres, Brachioradialis

Cubical fossa contents (***記: BMTR):

  1. ***Brachial artery —> divide into Ulnar + Radial artery
  2. ***Median nerve
  3. ***Tendon of Biceps brachii
  4. ***Radial nerve (+ deep branch)
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7
Q

Deep brachial artery (Profunda brachii artery)

A

Supply: ***Posterior arm

  • branch of Brachial artery
  • take part in anastomosis around elbow joint
  • **- Triangular interval
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8
Q

Ulnar artery

A

Supplies: Medial forearm

  • Medial branch of Brachial artery

Gives off:
1. ***Common interosseous artery
—> Anterior interosseous artery + Posterior interosseous artery (on anterior and posterior surface of interosseous membrane respectively)

  1. **Deep Palmar branch of ulnar artery —> **Superficial palmar arch

Pulse:

  • in front of wrist
  • 最出: ***lateral to Ulnar nerve, Flexor carpi ulnaris tendon, Pisiform bone
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9
Q

Radial artery

A

Supplies: Lateral forearm

  • Lateral branch of Brachial artery

Gives off:
- **Superficial Palmar branch of radial artery —> **Deep palmar arch

Pulse:

  • in front of wrist
  • ***lateral to Flexor carpi radialis tendon
  • In ***Anatomical snuffbox (Extensor pollicis longus, Extensor pollicis brevis, Abductor pollicis longus)
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10
Q

Superficial and Deep palmar arches

A

Anastomosis of Radial and Ulnar arteries

Superficial palmar arch:
- from Deep palmar branch of Ulnar artery

Deep palmar arch:
- from Superficial palmar branch of Radial artery

—> Gives off branches to digits

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11
Q

Main arteries of lower limb

A
  1. Femoral artery
  2. Deep femoral artery
  3. Popliteal artery
  4. Anterior tibial artery
  5. Posterior tibial artery
  6. Dorsalis pedis artery
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12
Q

Blood flow in lower limb

A 
Abdominal aorta
—> Common iliac artery
—> External iliac artery
—> Femoral artery (Deep femoral artery —> ***Circumflex femoral artery —> ***Retinacular arteries)
(—> Femoral triangle —> Adductor canal —> Adductor hiatus —> Popliteal fossa)
—> Popliteal artery
—> Anterior + Posterior tibial artery
—> Dorsalis pedis artery
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13
Q

Femoral artery

A

Location:
- direct continuation from External iliac artery

  • enter Femoral triangle midway between ASIS and Pubic symphysis
    —> mid-inguinal point
    —> **Femoral triangle (superficial: covered by skin and fascia only, easily accessible for cannulation, **NAV: medial to lateral, Femoral artery夾係中間)
    —> **Adductor/Subsartorial canal in medial aspect of middle 1/3 of thigh
    —> **    Adductor hiatus (gap in Adductor magnus)
    —> ***Popliteal fossa
    —> becomes Popliteal artery
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14
Q

Femoral triangle borders

A
  • ASIS (角落)
  • Pubic symphysis (角落)
  • Inguinal ligament (upper border)
  • Sartorius (lateral border)
  • Adductor longus (medial border)
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15
Q

Deep femoral artery (Profunda femoris artery)

A

Supply: Thigh

  • branch of Femoral artery
  • Branches:
    —> Medial + Lateral **Circumflex femoral arteries
    —> **    Retinacular arteries (supply femur head, 4 perforating arteries)
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16
Q

Popliteal artery

A
  • pulse more difficult to feel due to deepest structure in popliteal fossa
  • NVA arrangement (superficial to deep: Tibial nerve, Popliteal vein, Popliteal artery) in popliteal fossa

Gives off:

  • Anterior tibial arteries
  • Posterior tibial arteries
17
Q

Anterior tibial artery

A

Supplies: ***Anterior leg

Location:
- enter Anterior leg through opening in interosseous membrane

Continue as:
- ***Dorsalis pedis artery

Pulse:

  • palpable just above ankle joint
  • between **Tibialis anterior and **Extensor hallucis longus tendon
  • midway between 2 malleoli
18
Q

Posterior tibial artery

A

Supplies: ***Posterior leg (together with its branch Peroneal / Fibular artery)

Branch:
- ***Peroneal/Fibular artery

Gives off:
- Turn medially in distal half of leg
—> Medial + Lateral **Plantar arteries in foot
—> **Plantar arch (from lateral plantar arteries)

Pulse:
- midway between tip of medial malleolus and medial margin of heel

19
Q

Dorsalis pedis artery

A

Branches:

  • ***Lateral tarsal artery
  • ***Arcuate artery

Pulse:
- readily palpable on dorsum of foot (pressing against tarsal bone) just ***lateral to Extensor hallucis longus tendon (big toe tendon)

20
Q

Genicular anastomosis

A

***Genicular arteries —> provide alternative channels for blood to reach distal limb if popliteal artery blocked

Contributed by:

  1. Femoral artery
  2. Popliteal artery
  3. Tibial arteries
21
Q

Veins

A

Divided into (被deep fascia隔開):

  1. Deep veins
    - travel with arteries with same name
    - drain deeper structures (e.g. muscles, bones, joints)
    - found deep to muscles
    - usually paired when accompanying medium sized arteries (    Venae comitantes)
    - valves present
  2. Superficial veins
    - run in superficial fascia (superficial to muscle)
    - drain SC tissue
    - externally visible
    - communicate with deep veins at regular intervals by **Perforating / Communicating veins (pierce **deep fascia)
    - valves present to direct blood from superficial to deep vein —> systemic veins
    - Clinically important: Venipuncture, Transfusion
    - Prone to Varicosities (lower limb)
Upper limb venous blood flow:
Superficial veins
—> Deep veins
—> Axillary vein
—> Subclavian vein
—> Brachiocephalic vein
—> SVC
—> RA
Lower limb venous blood flow:
Superficial veins
—> Deep veins
—> Femoral vein
—> External iliac vein
—> Common iliac vein
—> IVC
—> RA
22
Q

Venous tributary

A

A smaller vein drains into larger vein

23
Q

Mechanism of venous return

A
  1. Valves
  2. Muscular pump
  3. Pulsation of adjacent artery (Venae comitantes: 中間artery撐開兩邊vein —> squeeze venous blood)
24
Q

Main superficial veins of upper limb

A
  1. Dorsal venous network (back of hand)
  2. Cephalic vein (lateral)
    - visible at ***snuffbox
    - runs up lateral forearm and arm
    - important superficial vein found in roof of Cubital fossa
  3. Basilic vein (medial)
    - from medial side of ***Dorsal venous network
    - join Brachial veins —> Axillary vein
    - important superficial vein found in roof of Cubital fossa
  4. Median Cubital vein
    - **anastomosis between Cephalic and Basilic vein
    - common site for **    drawing blood
    - important superficial vein found in roof of Cubital fossa
Blood flow:
Dorsal venous network
1. —> Cephalic —> Axillary
2. —> Cephalic —> Median Cubital —> Basilic —> Axillary
2. —> Basilic —> Axillary
25
Q

Main superficial veins of lower limb

A
  1. Dorsal venous arch (foot dorsum)
  2. Great saphenous vein (medial)
    - from medial arch (2/3 cm anterior to medial malleolus: accessible for venous cutdowns) —> medial leg —> behind knee —> medial thigh —> Saphenous opening (in deep fascia of thigh, 3/4 cm lateral and below pubic tubercle) —> Femoral vein
    - used as graft in coronary bypass surgery
  3. Small saphenous vein (back)
    - from lateral arch —> back of leg —> Popliteal vein at popliteal fossa

Blood flow:
Dorsal venous network (plantar arch)
1. Great saphenous vein —(Saphenous opening)—> Femoral vein
2. Small saphenous vein —> Popliteal vein —> Femoral vein

26
Q

(venous cutdown)

A

(emergency procedure in which vein is exposed surgically and cannula inserted into vein under direct vision
—> vascular access in trauma / hypovolemic shock patients when peripheral cannulation is difficult)

27
Q

Lymphatic

A
  1. Superficial
    - SC tissue
    - travel along superficial vein
    - e.g. basilic, cephalic, median cubital vein with **Axillary LN, **Cubital LN
    - e.g. great saphenous vein with **Superficial, **Deep inguinal LN
    - e.g. small saphenous vein with ***Popliteal LN
  2. Deep
    - travel along deep blood vessels
  • **Axillary lymph nodes:
  • drain upper limb
  • mammary gland
  • skin, superficial fascia of trunk above umbilicus and hip
  • **Inguinal lymph nodes:
  • drain lower limb
  • external genitalia
  • mucous membrane of lower half of anal canal
  • skin, superficial fascia of trunk below umbilicus

MSS (32 decks)

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