UE Angiology Flashcards
- artery that, on the right side, originates from the brachiocephalic trunk, and on the left side branches directly off the aortic arch
- divided into three regions by the anterior scalene M.: region 1 (proximal to anterior scalene), region 2 (deep to anterior scalene), and region 3 (distal to anterior scalene, proximal to 1st rib)
subclavian artery
What vessels comprise region 1 of the subclavian artery?
(proximal to anterior scalene M.)
- vertebral A.: travels superiorly in transverse foramina of cervical vertebrae
- internal thoracic A.: travels inferiorly to supply posterior aspect of anterior thoracic wall
- thyrocervical trunk: inferior thyroid A. (travels superiorly to supply thyroid gland, gives rise to ascending cervical A. which supplies lateral muscles of superior neck), suprascapular A. (travels through suprascapular notch over the transverse scapular L. to the posterior aspect of scapula to supply supraspinatus and infraspinatus Ms.)
- transverse cervical A.: travels posteriorly across neck, can branch into superficial (trapezius) and deep (levator scap and rhomboids), if no branching then it travels deep to trapezius
- artery that travels through suprascapular notch over the transverse scapular L. to the posterior aspect of scapula to supply supraspinatus and infraspinatus Ms.
- part of region 1 of subclavian, branches off the thyrocervical trunk
suprascapular A.
What vessels comprise region 2 of the subclavian artery?
(deep to anterior scalene M.)
- costocervical trunk: originates posteriorly from the subclavian A. before branching into its two terminal branches, suprememe intercostal A. and deep cervical A.
What vessels comprise region 3 of the subclavian artery?
(distal to the anterior scalene M., proximal to the 1st rib)
- dorsal scapular A.: variable, supplies levator scapulae and rhomboid Ms., if arising from transverse cervical A., it is deep branch
- artery that is a continuation of the subclavian A., distal to the 1st rib
- divided into 3 regions by the pectoralis minor M.: region 1 (distal to the 1st rib, proximal to pec minor), region 2 (deep to pec minor), region 3 (distal to pec minor, proximal to teres major)
axillary A.
What vessels comprise region 1 of the axillary A.?
(distal to the 1st rib, proximal to pectoral minor M.)
- superior thoracic A.: travels to the thoracic wall, supplies 1st and 2nd intercostal spaces and superior most serratus anterior M.
What vessels comprise region 2 of axillary A.?
(deep to pectoralis minor M.)
- thoracoacromial trunk: produces pectoral, acromial, clavicular, and deltoid branches, supplies pectoralis major, pectoralis minor, and deltoid Ms., acromion, and clavicle
- lateral thoracic A.: travels along the lateral border of pectoralis minor M. supplying pectoralis major M., pectoralis minor M., serratus anterior M., and intercostal Ms.
What vessels comprise region 3 of the axillary A.?
(distal to pectoralis minor M., proximal to teres major M.)
- subscapular A.: largest, yet shortest branch of axillary A., after its origin it quickly terminates into its two terminal branches, circumflex scapular A. (travels around lateral border of scapula, where it is visible in the triangular space, into the infraspinous fossa where it contributes to scapular anastomosis) and thoracodorsal A. (continues the direction of subscapular A., supplies latissimus dorsi)
- anterior circumflex humeral A.: smaller of humeral circumflex arteries, travels around surgical neck of humerus anteriorly, anastomoses w/ posterior circumflex A., supplies glenohumeral joint and head of humerus
- posterior circumflex humeral A.: larger of humeral circumflex arteries, travels around surgical neck posteriorly, where it is visible in quadrangular space, anastomoses w/ anterior circumflex, supplies surrounding musculature and glenohumeral joint
- region __ of the axillary A. is susceptible to aneurysm in individuals experiencing repeated rapid arm movements (baseball pitchers)
- can compress brachial plexus, leading to pain and loss of sensation
- region 1 of axillary A.
What are the 3 main arteries that create anastamoses around the scapula?
Where must you cut off blood supply to prevent collateral circulation?
- suprascapular, dorsal scapular, and circumflex scapular As.
- to cut off all blood supply to arm, ligation must be distal to subscapular A. of axillary A.
- ligation between thyrocervical trunk and subscapular A. results in reversal of blood flow in subscapular A. due to collateral circulation arriving via suprascapular, transverse cervical, and intercostal As. to the scapular region and continued feed of arterial blood to brachial A.
- continuation of axillary A., distal to teres major M., begins medial to humerus, travels to anterior surface before branching into its two terminal branches in the cubital fossa
- gives rise to multiple branches: deep brachial A., muscular branches, humeral nutrient A., superior ulnar collateral A., inferior ulnar collateral A., ulnar A., and radial A.
brachial A.
- branches from the brachial A. immediately distal to teres mjaor M., travels w/ the radial N. around the humerus, supplies posterior brachial muscles and terminates as two branches that feed into the elbow anastamosis
- middle collateral A. (posterior to lateral humeral epicondyle, anastomoses w/ recurrent interosseous A. of the ulnar A.)
- radial collateral A. (anterior to the lateral humeral epicondyle, anastomoses w/ the radial recurrent A. of the radial A.)
deep brachial A.
Determine what branches off the brachial A. these are based upon their description:
a) many unamed branches arise from brachial A. to supply muscles of anterior brachial compartment
b) enters humeral nutrient canal to supply humerus
c) originates halfway down brachial A., travels w/ ulnar N. behind medial humeral epicondyle where it anastomoses w/ posterior ulnar recurrent A. of ulnar A.
d) originates distal to the origin of the superior ulnar collateral A., travels anterior to medial humeral epicondyle where it anastomoses w/ anterior ulnar recurrent A. of ulnar A.
a) muscular branches
b) humeral nutrient A.
c) superior ulnar collateral A.
d) inferior ulnar collateral A.
- larger of the two terminal branches of the brachial A.
- branches in the cubital fossa, descends through antebrachium supplying mostly flexor muscles of the forearm, enters the hand passing over the flexor retinaculum, terminates as the superficial palmar arch and deep palmar branch
- branches: anterior/posterior ulnar recurrent As., common interosseous A. (anterior/posterior), palmar/dorsal carpal branches, superficial/deep palmar branches
ulnar A.
- branches off the ulnar A.
a) travels superiorly anterior to the medial humeral epicondyle where it anstomoses w/ the inferior ulnar collateral A.
b) travels superiorly posterior to the medial humeral epicondyle where it anastomoses w/ the superior ulnar collateral A.
a) anterior ulnar recurrent A.
b) posterior ulnar recurrent A.
a) branch off the ulnar A., travels laterally to the interosseous membrane, branches into anterior/posterior divisions
b) anterior division: travels along anterior surface of interosseous membrane, sends perforating branches through interosseous membrane to supply deep muscles of posterior forearm, terminates by replacing posterior interosseous A., then feeding into dorsal carpal arch
c) posterior division: produces interosseous recurrent A., then travels between deep and superficial layers of extensor muscles, receives anterior interosseous A. immediately proximal to wrist, terminates into dorsal carpal arch
d) branches from posterior interosseous A. in the posterior antebrachial compartment, travels superiorly behind lateral humeral epicondyle where it anastomoses w/ middle collateral A.
a) common interosseous A.
b) anterior interosseous A.
c) posterior interosseous A.
d) interosseous recurrent A.
- branch off the ulnar A.
- travels along anterior aspect of the wrist, anastomoses w/ palmar carpal branch of the radial A. to form palmar carpal arch
- palmar carpal arch: overlies anterior aspect of carpal bones
palmar carpal branch of the ulnar A.
- branch off the ulnar A.
- travels laterally around the wrist to the dorsal aspect to anastomose w/ dorsal carpal branch of the radial A. to form dorsal carpal arch
- dorsal carpal arch: formed by the dorsal carpal branches of the radial and ulnar As. and the anterior interosseous A., gives rise to four dorsal metacarpal As.
dorsal carpal branch of the ulnar A.
a) formed by the dorsal carpal branches of the radial and ulnar As. and the anterior interosseous A., gives rise to four dorsal metacarpal As.
b) three branches, form anastomosis w/ perforating branche from deep palmar arch then produce dorsal digital As.
c) formed by dorsal metacarpal A. and peforating branches from deep palmar arch, supply medial side of the 2nd digit and both sides of the 3rd, 4th, and 5th digits
a) dorsal carpal arch
b) dorsal metacarpal A.
c) dorsal digital A.
- branch off the ulnar A.
- continuation of the ulnar A., immediately deep to the palmar aponeurosis, supply the medial side of the 2nd digit and both sides of the 3rd, 4th, and 5th digits, and communicates w/ the radial A. via the palmar branch of the radial A.
- gives rise to palmar digital A., palmar metacarpal A., and proper palmar digital A.
superficial palmar arch
- branches off the superficial palmar arch
a) travels to the medial aspect of the 5th digit
b) three large branches that anastomose w/ palmar metacarpal As. from the deep palmar arch, forming common palmar digital As., which individually divide into two proper palmar digital As.
c) six arteries that originate from common palmar digit A., travel along the lateral and medial aspect of adjacent separate digits, starting w/ the medial side of the 2nd digit, ending w/ the lateral aspect of the 5th digit
a) palmar digital A.
b) palmar metacarpal A.
c) proper palmar digit A.
- smaller of the two terminal branches of the brachial A.
- branches in the cubital fossa, descends through the antebrachium supplying both flexor and extensor muscle of the forearm, travels through the anatomical snuff box, posteriorly around the pollux, then anteriorly to enter the palm between the two heads of the 1st dorsal interosseous M. where it terminates as the deep palmar arch
- gives rise to: radial recurrent A., palmar/dorsal carpal branches, palmar branch, dorsalis pollicis A., 1st dorsal metacarpal A., princeps pollicis A., radialis indicis A., and deep palmar arch
radial A.
- branch off the radial A.
- travels superiorly anteiror to the lateral humeral epicondyle where it anastomoses w/ the radial collateral A.
radial recurrent A.
- branch off the radial A.
- travels along the anterior aspect of the wrist anastomoses w/ the palmar carpal branch of the ulnar a. to for the palmar carpal arch
- palmar carpal arch: overlies the anterior aspect of the carpal bones
palmar carpal branch of the radial A.
- branch off the radial A.
a) travels laterally around the wrist to the dorsal aspect to anastomose w/ the dorsal carpal branch of the ulnar A. to form the dorsal carpal arch, which is also fed into from the posterior interosseous A.
b) formed by the dorsal carpal branches of the radial and ulnar As. and the anterior interosseous A., gives rise to four dorsal metacarpal As.
c) four branches, form an anastomosis w/ perforating branches from the deep palmar arch then produce dorsal digital As.
d) formed by dorsal metacarpal A. and perforating branches from the deep palmar arch, supply the medial side of the 2nd digit and both sides of the 3rd, 4th, and 5th digits
a) dorsal carpal branch
b) dorsal carpal arch
c) dorsal metacarpal A.
d) dorsal digital A.
- branches off the radial A.
a) arises from the radial A. on the anterior aspect of the carpal bones, feeds into the superficial palmar arch, which is principally supplied by the ulnar A.
b) arises from the radial A. at the base of the 1st metacarpal, travels along the lateral aspect of the pollux
c) arises from the radial A., supplies adjacent sides of the 1st and 2nd digits
d) arises from the radial A. before the radial A. turns laterally to form the deep palmar arch, travels along the medial aspect of the pollux
e) arises from either the radial A. or the princeps pollicis A., travels along the lateral aspect of the 2nd digit
a) palmar branch of the radial A.
b) dorsalis pollicis A.
c) 1st dorsal metacarpal A.
d) princeps pollicis A.
e) radialis indicis A.
- continuation of the radial A. in the deep palm, communicates w/ the deep palmar branch of the ulnar A., produces palmar metacarpal A. and perforating branches
- palmar metacarpal A. (three branches, travel distally to feed into the common palmar digits As. from the superficial palmar arch
- perforating branches (travel posteriorly to feed into the dorsal metacarpal A. from the dorsal carpal arch
deep palmar arch of the radial A.
Figure of general hand arterial supply:
(good study tool)
- continuation of the axillary V. proximal to the 1st rib, forms the brachiocephalic V. w/ the internal jugular V.
subclavian V.
- vein formed in the medial brachium when the numerous brachial veins unite w/ the superficial basilic V.
- derived from the cephalic V., brachial Vs., and basilic V.
- becomes subclavian V. proximal to 1st rib
axillary V.
- superficial vein, drains the dorsal venous network, communicates w/ the basilic V. via the medial cubital V., travels in the deltopectoral groove, traverses the clavipectoral triangle and empties into the axillary V.
- median cubital V. (communicating branch between the cephalic and basilic V., overlies the bicipital aponeurosis)
- dorsal venous network: superficial venous plexus on the dorsum of the hand, feeds laterally into the cephalic V.)
cephalic V.
- most common site of venipuncture because of its superficial location and the protection of underlying deep structures by the bicipital aponeurosis
median cubital V.
- multiple anastomosing vessels that accompany the brachial A.
- drains the ulnar, radial, posterior, and anterior interosseous Vs., unites w/ the basilic V. to form the axillary V.
brachial Vs.
- paired, anastomosing veins that accompany the ulnar A., drain the venous arches and empty into the brachial Vs.
- deep palmar venous arch (anastomosing, irregular often paired venous arch, accompanies the deep palmar arteral arch)
- superficial palmar venous arch (anastomosing, irregular often paired venous arch, accompanies the superficial palmar arterial arch)
ulnar Vs.
- paired, anastomosing veins that accompany the radial A., drain the venous arches and empty into the brachial Vs.
- deep palmar venous arch (anastomosing, irregular often paired venous arch, accompanies the deep palmar arterial arch)
- superficial palmar venous arch (anastomosing, irregular often paired venous arch, accompanies the superficial palmar arterial arch)
radial Vs.
- paired, anastomosing veins that accompany the posterior interosseous A., empty into the brachial veins
- paired, anastomosing veins that accompany the anterior interosseous A., empty into the brachial veins
- posterior interosseous Vs.
- anterior interosseous Vs.
- superficial vein, drains the dorsal venous network and the median antebrachial V., forms the axillary V. by uniting w/ the brachial Vs.
- median antebrachial V. (drains the anterior aspect of the forearm, communicates w/ the deep veins via perforating veins, capable of producing median basilic V. and median cephalic V.)
- dorsal venous network (superficial venous plexus on the dorsum of the hand, feeds medially into the basilic V.
basilic V.
- originates as the chyle cistern in the abdomen
- drains lymph from the lower extremities, pelvis, abdomen, left half of the thorax, left upper extremity, and left side of the head/beck superiorly
- empties into the venous system near the junction of the left internal jugular V. and left subclavian V.
- in the thorax it drains the subclavian lymphatic trunk and bronchomediastinal trunk
thoracic duct
- drains primarily the subclavian lymphatic trunk and the bronchomediastinal trunk
- empties into the brachiocephalic V. near its origin
right lymphatic duct
- drains the numerous superficial lymphatic vessels, empties into the thoracic duct
- superficial lymphatic vessels (drain lymphatic plexuses of the UE): lymphatic plexuses (vast subcutaneous plexuses in the digits and palm that simplify the formation of superficial lymphatic vessels
subclavian lymphatic trunk
What are the 3 groups of lymph nodes in the UE?
- cubital lymph nodes: located proximal to the medial humeral epicondyle and medial to the basilic V., communicate w/ the humeral axillary lymph nodes
- axillary lymph nodes: collection of five groups of lymph nodes in the axilla
- deltopectoral lymph nodes: superficial group of lymph nodes near the cephalic V. at the clavipectoral triangle
What are the 5 groups of axillary lymph nodes?
- pectoral axillary: receive lymph from the breast and lateral thoracic wall
- subscapular axillary: receive lymph from the posterior thoracic wall and scapular region
- humeral axillary: receive lymph from nearly the whole UE, except the lymph vessels accompanying the cephalic V. which empty into the clavicular lymph nodes
- central axillary: receives lymph from the pectoral, subscapular, and humeral axillary lymph nodes
- apical axillary: receives lymph from the central axillary lymph nodes
- clinically important lymph nodes due to their frequent invasion by cancer cells from elsewhere in the body (usually breast)
axillary lymph nodes
