MSS18 Vascular Supply Of The Limbs Flashcards
Main arteries of upper limb
- Subclavian artery
- Axillary artery
- Brachial artery
- Deep Brachial artery
- Ulnar artery
- Radial artery
- Superficial and Deep palmar arches
Blood flow of upper limb main arteries
Subclavian —> Axillary —> Brachial + Deep Brachial —> Ulnar + Radial —> Deep + Superficial palmar arches —> Digital
Subclavian artery
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
***Axillary artery
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)
Scapular anastomosis
Anastomosis around both surfaces of Scapula —> alternative route of blood supply to upper limb
Contributed by:
- Branches of 1st part of Subclavian artery —> Thyrocervical trunk —> **Dorsal scapular artery + **Suprascapular artery
- Branches of 3rd part of Axillary artery —> ***Circumflex scapular artery (Triangular space)
Brachial artery
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):
- ***Brachial artery —> divide into Ulnar + Radial artery
- ***Median nerve
- ***Tendon of Biceps brachii
- ***Radial nerve (+ deep branch)
Deep brachial artery (Profunda brachii artery)
Supply: ***Posterior arm
- branch of Brachial artery
- take part in anastomosis around elbow joint
- **- Triangular interval
Ulnar artery
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)
- **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
Radial artery
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)
Superficial and Deep palmar arches
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
Main arteries of lower limb
- Femoral artery
- Deep femoral artery
- Popliteal artery
- Anterior tibial artery
- Posterior tibial artery
- Dorsalis pedis artery
Blood flow in lower limb
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
Femoral artery
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
Femoral triangle borders
- ASIS (角落)
- Pubic symphysis (角落)
- Inguinal ligament (upper border)
- Sartorius (lateral border)
- Adductor longus (medial border)
Deep femoral artery (Profunda femoris artery)
Supply: Thigh
- branch of Femoral artery
- Branches:
—> Medial + Lateral **Circumflex femoral arteries
—> **Retinacular arteries (supply femur head, 4 perforating arteries)
Popliteal artery
- 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
Anterior tibial artery
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
Posterior tibial artery
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
Dorsalis pedis artery
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)
Genicular anastomosis
***Genicular arteries —> provide alternative channels for blood to reach distal limb if popliteal artery blocked
Contributed by:
- Femoral artery
- Popliteal artery
- Tibial arteries
Veins
Divided into (被deep fascia隔開):
- 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 - 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
Venous tributary
A smaller vein drains into larger vein
Mechanism of venous return
- Valves
- Muscular pump
- Pulsation of adjacent artery (Venae comitantes: 中間artery撐開兩邊vein —> squeeze venous blood)
Main superficial veins of upper limb
- Dorsal venous network (back of hand)
- Cephalic vein (lateral)
- visible at ***snuffbox
- runs up lateral forearm and arm
- important superficial vein found in roof of Cubital fossa - Basilic vein (medial)
- from medial side of ***Dorsal venous network
- join Brachial veins —> Axillary vein
- important superficial vein found in roof of Cubital fossa - 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
Main superficial veins of lower limb
- Dorsal venous arch (foot dorsum)
- 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 - 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
(venous cutdown)
(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)
Lymphatic
- 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 - 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
