Upper Extremity Angiology

Question 1

Internal thoracic artery path

Answer 1

Travels inferiorly to supply the posterior aspect of the anterior thoracic wall

Question 2

Suprascapular artery path

Answer 2

Travels through suprascapular notch over the transverse scapular ligament to the posterior aspect of scapula to supply supraspinatus and infraspinatus muscles

Question 3

Transverse cervical artery path

Answer 3

Travels posteriorly across neck, branches into deep and superficial branches (if no branching, it travels to deep surface of trapezius)
Superficial branch- travels with spinal accessory nerve along deep surface of trapezius
Deep branch- if present, replaces dorsal scapular artery traveling along medial border of scapula supplying levator scapulae and rhomboid muscles

Question 4

When does the subclavian artery become the axillary artery

Answer 4

Once it is distal to the first rib

Question 5

Superior thoracic path

Answer 5

Branches off axillary artery, travels to thoracic wall, supplies 1st and 2nd intercostal spaces and superior portion of serratus anterior

Question 6

Axillary aneurism

Answer 6

Region one of the axillary artery is susceptible to aneurysm in individuals experience repeated rapid arm movements (pitchers) and can compress the brachial plexus, resulting in pain and loss of sensation

Question 7

Thoracoacromial trunk branches and what they supply

Answer 7

Pectoral, acromial, clavicular and deltoid branches

Supplies pectoralis major/minor, deltoid, acromion and clavicle

Question 8

Lateral thoracic artery path

Answer 8

Branches off axillary, travels along lateral border of pectoralis minor, supplying pectoralis major/minor, serratus anterior and intercostal muscles

Question 9

Subscapular artery branches/path

Answer 9

Distal to pectoralis minor, proximal to teres major
Branches into circumflex scapular and thoracodorsal
CS travels around lateral border of scapula, visible in triangular space, into infraspinous fossa to contribute to scapular anastomosis.
Thoracodorsal supplies latissimus dorsi

Question 10

Anterior/posterior circumflex humeral

Answer 10

ACH- smaller, supplies glenohumeral joint and head of humerus
PCH- visible in quadrangular space, supplies surround musculature and glenohumeral joint

Question 11

If you wanted to cut off all circulation to the arm, ligation of the axillary artery must occur where, and why

Answer 11

Ligation must be distal to the subscapular artery of the axillary artery. Due to extensive anastomosis in the scapula, ligation of axillary artery b/w thoracoacromial trunk and subscapular artery results in reversal of blood flow in the subscapular artery and continued feed of arterial blood to the brachial artery

Question 12

When does axillary artery become brachial artery

Answer 12

Distal to the teres major

Question 13

Deep brachial artery path

Answer 13

Branches from brachial A. just distal to teres major, travels with radial nerve around the humerus, branches into middle collateral and radial collateral arteries

Question 14

Middle collateral artery

Answer 14

Branches off of deep brachial artery, travels posterior to lateral humeral epicondyle, anastomosis w/recurrent interosseous A. from ulnar A.

Question 15

Radial collateral artery

Answer 15

Branches off brachial artery, travels anterior to lateral humeral epicondyle, anastomosis with radial recurrent A.

Question 16

Humeral nutrient artery

Answer 16

Branch of brachial artery, supplies humerus

Question 17

Superior ulnar collateral artery

Answer 17

Branch of brachial artery

Travels with ulnar nerve behind medial epicondyle where it anastomosis with posterior ulnar recurrent A.

Question 18

Inferior ulnar collateral artery

Answer 18

Branch of brachial artery

Travels anterior to medial epicondyle and anastomosis with anterior ulnar recurrent artery

Question 19

Ulnar artery

Answer 19

Terminal branch of brachial A., forms in cubital fossa
Descends through antebrachium supplying mostly flexors, enters hand over flexor retinaculum, terminates as superficial palmar arch and deep palmar branch

Question 20

Anterior/posterior ulnar recurrent

Answer 20

Branch off ulnar, travel superiorly through arm, anterior branch goes anterior to medial epicondyle and anastomosis with inferior ulnar collateral, posterior branch goes posterior to medial epicondyle and anastomosis with superior ulnar recurrent

Question 21

Common interosseous artery

Answer 21

Branches off ulnar artery, then branches into anterior and posterior interosseous arteries

Question 22

Anterior interosseous artery

Answer 22

Branches off common interosseous, travels anterior to interosseous membrane, perforates membrane and supplies deep posterior forearm muscles, replaces posterior interosseous artery just proximal to wrist and then feeds into dorsal carpal arch

Question 23

Posterior interosseous artery

Answer 23

Branches off common interosseous, produces interosseous recurrent artery and then receives anterior interosseous artery and terminates into dorsal carpal arch
Interosseous recurrent- travels superiorly, behind medial epicondyle, anastomosis with middle collateral artery

Question 24

Palmar carpal branch of ulnar artery

Answer 24

Travels along anterior wrist, anastomosis with palmar carpal branch of radial artery to produce palmar carpal arch

Question 25

Dorsal carpal branch of ulnar artery

Answer 25

Travels laterally around wrist into dorsal aspect to anastomosis with dorsal carpal branch of radial artery to produce dorsal carpal arch

Question 26

Dorsal carpal arch

Answer 26

Formed from the two dorsal carpal branches and the anterior interosseous artery Forms dorsal metacarpal arteries which join with perforating branches of deep palmar arch to form digital arteries supplying medial side of digit 2 and both sides of 3,4,5

Question 27

Superficial palmar arch

Answer 27

Continuation of ulnar artery Supplies medial side of digit 2 and all of 3,4,5 Communicates with palmar branch of radial artery Gives rise to palmar metacarpal and digital arteries

Question 28

Deep palmar branch of ulnar artery

Answer 28

Feeds into deep palmar arch (which is principally supplied by radial artery)

Question 29

Radial artery

Answer 29

Smaller of the terminal branches of brachial artery Branches in cubital fossa Descends through antebrachium supplying flexors and extensors of forearm, travels through anatomical snuff box and then posteriorly around thumb, then anteriorly to enter palm and terminate as deep palmar arch

Question 30

Radial recurrent artery

Answer 30

Travels superiorly anterior to lateral epicondyle where it anastomosis with radial collateral artery

Question 31

Palmar carpal branch of radial artery

Answer 31

Anastomoses with palmar carpal branch of ulnar artery to form palmar carpal arch

Question 32

Dorsal carpal branch

Answer 32

Travels laterally around wrist to anastomosis with dorsal carpal branch of ulnar artery to form dorsal carpal arch

Question 33

Palmar branch of radial artery

Answer 33

Feeds into superficial palmar arch, which is principally supplied by ulnar artery

Question 34

Dorsalis pollicis artery

Answer 34

Arises from radial artery at base of 1st metacarpal, travels along lateral aspect of thumb

Question 35

1st dorsal metacarpal artery

Answer 35

Branch of radial artery, supplies adjacent sides of 1st and 2nd digits

Question 36

Princeps pollicis artery

Answer 36

Branch of radial artery, travels along medial aspect of thumb

Question 37

Radialis indicis artery

Answer 37

Arises from radial artery or princeps pollicis artery | Travels along lateral aspect of 2nd digit

Question 38

Deep palmar arch

Answer 38

Continuation of radial artery, communicates with deep palmar branch of ulnar artery, produces palmar metacarpal and perforation branches

Question 39

Subclavian vein

Answer 39

Continuation of axillary vein proximal to the 1st rib, forms brachiocephalic vein with the internal jugular vein

Question 40

Axillary vein

Answer 40

Formed in the medial brachium when multiple brachial veins unite with superficial basilic vein

Question 41

Cephalic vein

Answer 41

Drains dorsal venous network (from dorsum of hand), communicates with basilic vein via median cubital vein Travels in deltopectoral groove, traverses clavipectoral triangle, empties into axillary vein

Question 42

Median cubital vein

Answer 42

Connects basilic and cephalic veins Overlies bicipital aponeurosis Most common site of venipuncture because of its superficial location

Question 43

Brachial veins

Answer 43

Multiple anastomosing vessels that accompany brachial artery | Drains ulnar, radial, posterior and anterior interosseous veins, unites with basilic vein to form axillary vein

Question 44

Ulnar vein

Answer 44

Accompany ulnar artery, drains superficial and deep palmar venous arches and empty into brachial veins

Question 45

Basilic vein

Answer 45

Drains dorsal venous network of hand and median antebrachial vein (drains anterior aspect of forearm), forms axillary vein after uniting with brachial veins

Question 46

Thoracic duct

Answer 46

Originates as chyle cistern in the abdomen Drains lymph from lower extremeties, abdomen, pelvis, left half of thorax, left upper extremity and left side of head and neck superiorly In thorax it drains subclavian lymphatic trunk and bronchomediastinal trunk

Question 47

Left Subclavian lymphatic trunk

Answer 47

Receives drainage from lymphatic plexuses of upper extremity, empties into thoracic duct

Question 48

Right lymphatic duct

Answer 48

Drains right subclavian lymphatic trunk and bronchomediastinal trunk Empties into brachiocephalic vein

Question 49

Cubital lymph nodes

Answer 49

Proximal to medial humeral epicondyle and medial to basilic vein, communicate with humeral axillary nodes

Question 50

Axillary lymph nodes

Answer 50

``` Five groups of nodes in the axilla Pectoral Subscapular Humeral axillary Central axillary Apical axillary ```

Question 51

Pectoral axillary lymph nodes

Answer 51

Receive lymph from breast and lateral thoracic wall

Question 52

Subscapular axillary lymph nodes

Answer 52

Receive lymph from posterior thoracic wall and scapular region

Question 53

Humeral axillary lymph nodes

Answer 53

Receive lymph from nearly the whole upper extremity, except the lymph vessels accompanying the cephalic vein, which empty into clavicular nodes

Question 54

Central axillary lymph nodes

Answer 54

Receives lymph from pectoral, subscapular and humeral axillary nodes

Question 55

Apical axillary nodes

Answer 55

Receives lymph from central axillary nodes

Question 56

Deltopectoral lymph nodes

Answer 56

Lie near the cephalic vein at the clavipectoral triangle

Question 57

Importance of axillary lymph nodes

Answer 57

They are frequently invaded by cancer cells from elsewhere in the body, usually breast cancer