Revision: vasculature

Question 8

name major arteries

Answer 8

Question 9

name major veins

Answer 9

Question 10

name major coronary arteries and cardiac veins

Answer 10

anterior interventricular=left anterior descending

Question 11

name major coronary arteries and cardiac veins of posterior heart

Answer 11

Question 12

Describe the vasculature of the U/limb from the subclavian arteries

Answer 12

Subclavian -> Axillary artery at the lateral border of the 1st rib

Axillary becomes the posterior and anterior humral circumflex arteries that supplies the shoulder, as well as the subscapular artery, all at the level of the humeral surgical neck

Axillary becomes the brachial at the lower border of the teres M.

Brachial provides the profunda brachii immediately after the teres M that runs down the radial groove and ends by contributing to a network of vessels at the elbow

After the cubital fossa the brachial artery divides to the ulnar and radial arteries that supply the ant. and post. of the forearm, respectively

these then both form their own superficial and deep palmar arches that anastamose together- the superficial arch produces the common palmar digital arteries, that then divide to form the proper palmar digital arteries

Question 13

desc. clinical significance of arteries of the u/limb

Answer 13

Axillary aneurysm:

• caused by high BP, Marfan’s, baseball pitchers
• puts pressure on the brachial plexus, this then causes pain and anaesthesia in the cutaneous distribution of the affected nerve: axillary - regimental badge area, radial - back of arm and forearm as well as lateral dorsum of hand, ulnar: medial palmar and dorsum of hand, median: lateral palmar hand, muscolcutaneous: lateral forearm

Occlusion/laceration of brachial artery:

• this is an emergency as it can lead to infarction, paralysis, muscles being replaced by scar tissue and shortening leading to flexion deformity, Volkmann’s contracture:
• > permanent flexion contracture of hand at wrist, passive extension of fingers is painful and restricted, hand is blue/white and cold, radial pulse is absent, claw-like deformity of hand and fingers

Question 14

name vessels

Answer 14

Question 15

name vessels

Answer 15

Question 16

name vessels

Answer 16

Question 17

name vessels

Answer 17

proper palmar arches are at the top

Question 18

desc. veins of U/limb from cubital and basilic to axillary and clin. significance

Answer 18

cephalic runs down antero-lateral side of U/limb, basilic runs more medially

both are superficial and can normally be seen, connected by median cubital vein, used for venepuncture as it is relatively superficial and easily accessible

others run alongside the major arteries -> the vena comitantes

The basilic becomes the axillary vein at the lower border of the teres M, the cephalic joins the axillary between the pec M and deltoid

Question 19

name vessels

Answer 19

Question 20

name vessels

Answer 20

Question 21

desc. arteries of L/limb

Answer 21

Common iliac -> external and internal iliac:

internal -> (branch) obturator -> pelvic region via obturator foramen -> (medial thigh) post branch (distal deep gluteal muscles) and ant. branch (pectineus, obt. ext., adductors, gracillis)

external -> femoral as it passes the inguinal ligament and enters fem. triangle

fem. artery produces a branch called the profunda femoris -> perforating branches (3/4 arteries that perforate the add. mag. and supply some muscles in the medial and posterior thigh), lat. fem. circumflex (wraps around ant. femur and supplies some muscles in lat. side of thigh) and med. fem. circumflex (wraps around post. femur and supplies head and neck)
- the lateral circumflex supplies less blood to the femoral head as it has to penetrate the iliofemoral ligament

femoral artery moves down the ant. side of the thigh down the adductor canal (supplying add. muscles) and becomes popliteal artery as it moves through the adductor hiatus

popliteal artery gives off genicular branches that supply the knee joint and splits to form posterior and anterior tibial arteries

post. tib. artery: gives off fibular artery that supplies lat. side of leg, the rest of the post. tib. artery supplies the post. side of the leg

anterior tibial: supplies all muscles of ant. leg, moves through IO membrane and becomes the dorsalis pedis as it passes the ant. aspect of the ankle joint

Question 22

desc. clinical significance of arteries of L/limb

Answer 22

med. fem. circumflex artery wraps round the post. side of the femur and supplies the head and neck, in a fem. head frx this can be damaged causing avasc. necrosis of femur head

Athrosclerosis-> intermittent claudication

-Pain on walking that is then relieved by rest, a build up of an atherosclerotic plaque (therefore same risk factors as for CAD), limits flow to muscles -> ischaemia and pain

Pulses: easiest is femoral artery, midway between ASIS and pubic symphysis (ie. in the inguinal ligament)

popliteal is hardest as it is deep within the popliteal fossa, an aneurysm here forms an obviously palpatable pulsation in the popliteal fossa, which can lead to damage to the tibial nerve -> motor loss of post. leg muscles and anaesthesia

the dorsalis pedis can be palpated on the dorsum of the foot, medial to the EPL

Question 23

name vessels

Answer 23

Question 24

name vessels

Answer 24

Question 25

name vessels

Answer 25

Question 26

desc. veins of the L/limb from dorsal venous arch to external iliac

Answer 26

The dorsal venous arch mainly drains into superficial veins, the most important two being the Great and Small Saphenous veins, but it also forms deep veins, the anterior tibial:

GSV: from med. part of Dorsal venous arch, moves along medial leg anterior to the medial malleolus and post. to med. condyle in knee, drains into femoral vein just distal to the inguinal ligament

SSV: from lat. part of dorsal venous arch, moves up the post. leg, post. to lat. mall. and along lat. border of calc. tendon, it moves between the lat. and med. heads of the gastrocnemius and drains into the popliteal vein in the popliteal fossa

Deep veins: the anterior tibial vein comes from the dorsal venous arch, along with the post. tibial and the fibular vein it forms the popliteal vein that then forms the femoral vein as it passes through the adductor hiatus

The deep vein of the thigh drains into the femoral vein

The femoral vein becomes the external iliac vein at the level of the inguinal ligament

Question 27

name vessels

Answer 27

long = great saphenous veins

Question 28

name vessels

Answer 28

Question 29

name vessels

Answer 29

Question 30

name vessels

Answer 30

Question 31

clinical significance of veins of l/limb

Answer 31

Varicose veins: incompetent valves lead to superficial vein dilation

• this causes inc. pressure in veins -> damages cells, blood exudates to skin
• further problems can lead to brown pigmentation and ulceration
• treatments include: surgical movement of saph. system, reconstruction of valves, tying off affected valves

DVT: formation of blood clot in deep veins of l/limb, can lead to pulm. occlusion from the thrombus embolising and reaching the pulm. circulation, leads to cardio-pulmonary arrest

• can also lead to postphlebitic/post-thrombotic syndrome->chronic deep venous insufficiency, damage to venous valves, lymphoedema
• Prophylaxis: leg compression given in surgery, subcutaneous heparin
• Treatment: IV heparin, oral warfarin

Great saphenous vein can be used for venepuncture, skin incision anterior to medial malleolus, risk of saphenous nerve injury and pain along medial border of foot

Question 32

Femoral artery supply

Answer 32

its branches supply the anterior and antero-medial aspects of thigh

Question 33

Deep artery of thigh/profunda femoris

Answer 33

3/4 perforating branches pierce add. mag. -> muscles in med, lat and post. part of ant. compartment

Question 34

med. circumflex femoral supplies

Answer 34

head and neck of femur, transverse branch -> cruciate anastamoses of thigh, ascending branch -> inf. glut. artery

Question 35

lat. circumflex femoral supplies

Answer 35

ascending branch -> ant. part of glut. region, transverse branch -> winds around femur, descending branch -> genicular anastamoses of knee

Question 36

obturator artery supplies

Answer 36

ant. : triple A go, also pectineus
post. : muscles that attach to the ischial tuberosity - hamstrings apart from short head of biceps femoris

Question 37

Sup. glut. artery origin and supplies

Answer 37

post. division of internal iliac

sup branch -> glut. max, inf. branch -> glut med, min, TFL

Question 38

inf. glut. artery origin and supplies

Answer 38

post. division of internal iliac

glut max., ob. int., quad. fem., sup. parts of hamstrings

Question 39

internal pudental origin, supplies

Answer 39

ant. division of internal iliac

external genitalia, perineal muscles, NOT gluteal muscles

Question 40

popliteal artery supplies

Answer 40

sup, mid, inf genicular arteries to both lat. and med. aspects of knee

Question 41

ant. tibial artery supplies

Answer 41

ant. compartment of leg

Question 42

dorsalis pedia supplies

Answer 42

dorsal foot muscles, contributes to formation of deep palmar arch

Question 43

post. tibial artery supplies

Answer 43

post. and lat. leg

Question 44

fibial artery supplies

Answer 44

post. leg, perforating branches -> lat. leg