BLOOD VESSELS ANATOMY PDF

BLOOD VESSELS Laurence Owen R. Bundal M.D. General Surgery peripheral vascular system all the blood vessels that exist outside the heart. The peripheral vascular system is classified as follows: aorta and its branches: arterioles capillaries venules and veins...

BLOOD VESSELS Laurence Owen R. Bundal M.D. General Surgery peripheral vascular system all the blood vessels that exist outside the heart. The peripheral vascular system is classified as follows: aorta and its branches: arterioles capillaries venules and veins Intima- frictionless pathway Media- regulates diameter Adventitia- Support and shape BLOOD VESSELS Head and Neck Chest Abdomen Pelvic and Perineum Extremities BLOOD VESSELS Head and Neck Chest Abdomen Pelvic and Perineum Extremities Arteries of the Head and Neck There are several major arteries responsible for the blood supply of the head and neck: External carotid arteries Internal carotid arteries Vertebral arteries Thyrocervical trunk Common Carotid Artery Common Carotid Artery Internal Carotid Artery  External Carotid Artery Source Common carotid artery (at the level of the thyroid cartillage in the larynx) Branche Superior thyroid artery s Ascending pharyngeal artery Lingual artery Facial artery Occipital artery Posterior auricular artery Maxillary artery Superficial temporal artery  Vertebral Artery Segments Preforaminal (from subclavian artery to transverse foramen of C6) Foraminal (through the transverse foramina of C6 to C2) Extradural (from the transverse foramen of axis to the vertebral canal) Intradural (from the vertebral canal to the inferior border of pons) Branches Anterior spinal, posterior spinal, posterior inferior cerebellar, meningeal, medullary, basilar arteries  Thyrocervical trunk Origin Subclavian artery Branches Inferior thyroid artery ascending cervical artery, suprascapular artery transverse cervical artery Supply Inferior part of the thyroid gland, parathyroid glands, larynx, pharynx, platysma, brachial plexus, deep cervical and shoulder muscles, skin of the neck and shoulders Veins of the head and neck Jugular Veins There are three main jugular veins – external, internal and anterior. They are ultimately responsible for the venous drainage of the whole head and neck.  External Jugular Vein Drains Confluence of posterior from division of the retromandibular vein with the posterior auricular vein Tributaries Cervical, suprascapular, anterior jugular veins Drains to Subclavian vein Drainage Scalp, face area  Internal Jugular Vein Drains from Sigmoid sinus Tributaries Inferior petrosal sinus, vein of cochlear duct, meningeal veins, pharyngeal venous plexus, lingual vein, common facial vein, sternocleidomastoid vein, superior and middle thyroid vein Drains to Brachiocephalic vein Drainage Brain, skull, oral cavity, superficial area structures of face and neck  Anterior Jugular Vein Drains Confluence of superficial from submandibular veins Tributaries Laryngeal, small thyroid, inferior thyroid veins Drains to External jugular vein (occasionally subclavian vein) Drainage Anterior compartment of area neck BLOOD VESSELS Head and Neck Chest Abdomen Pelvic and Perineum Extremities  Arteries and veins of the thoracic wall Posterior Origin – superior intercostal artery & thoracic aorta intercostal artery Branches – dorsal, spinal, medial and lateral musculocutaneous, and small collateral arteries Subcostal artery Origin – thoracic aorta Branches – superior and inferior branches Internal thoracic Origin – the first part of the subclavian artery artery Branches – Musculophrenic, Superior epigastric arteries, Anterior intercostal, Perforating and Sternal branches Anterior Origin – Internal thoracic artery intercostal artery Branches – Superior and inferior branches Posterior Drains to the brachiocephalic vein, the superior intercostal veins intercostal vein drains to left brachiocephalic & azygous vein, and the azygous/hemizygous system Anterior Drain to the internal thoracic vein and the intercostal veins musculophrenic vein Internal thoracic Single vein that drains to the brachiocephalic vein vein  Intercostal Arteries and Vein Each intercostal space contains: a large single posterior intercostal artery and 2 small anterior intercostal arteries A single anterior and posterior intercostal vein  Posterior intercostal Posterior Intercostal arteries Artery The posterior intercostal arteries of the first two spaces are branches from the superior intercostal artery, a branch of the costocervical trunk of the subclavian artery The posterior intercostal arteries of the lower nine space are branches of the descending thoracic aorta Anterior intercostal Artery Internal thoracic Artery Posterior intercostal Vein Azygos Veins Internal Thoracic Vein BLOOD VESSELS Head and Neck Chest Abdomen Pelvic and Perineum Extremities  Blood vessels of Abdomen and Pelvis Arterial supply Parietal and visceral branches of the abdominal aorta Venous drainage Inferior vena cava *stomach, intestines, pancreas and spleen first drain to the liver via the hepatic portal vein Abdominal Visceral: celiac trunk, superior mesenteric artery, aorta branches middle suprarenal arteries, renal arteries, gonadal arteries, inferior mesenteric artery Parietal: inferior phrenic artery, lumbar arteries, median sacral artery Terminal: common iliac arteries Inferior vena Lumbar veins, right gonadal vein, renal veins, right cava tributaries suprarenal vein, inferior phrenic veins, hepatic veins 10 Branches of Abdominal aorta Aorta Aorta Branches: 3 Anterior visceral branches: Celiac trunk, superior mesenteric and inferior mesenteric arteries 3 Lateral visceral branches: Suprarenal, renal and testicular( or ovarian arteries) 5 Lateral abdominal wall branches Inferior phrenic and 4 lumbar arteries 3 terminal branches: 2 common iliac arteries and median sacral artery Common Iliac arteries Right and left common arise at the level of L4 lumbar vertebra and run downward and laterally along the medial border of psoas muscle. External Iliac artery It gives off inferior epigastric and deep circumflex iliac branches. It enter the thigh by passing under inguinal ligament to become femoral artery Internal Iliac artery It passes down into pelvis in front of sacroiliacjoint to supply pelvic organs  Arterial supplyArterial of GIT Supply of GIT Celiac artery The artery of foregut and supplies GIT from lower 1/3 esophagus to middle of 2nd part of duodenum Superior mesenteric artery Artery of midgut and supplies GIT from middle of 2nd part of duodenum till distal 1/3 of transverse colon Inferior mesenteric artery Artery of hindgut and supplies large intestine from distal 1/3 of transverse colon to anal canal  Celiac Artery Celiac Artery Aries from abdominal aorta at the level of T12.. It has 3 terminal branches: Left gastric , splenic and hepatic arteries Left gastric smallest and the first branch that arises from the celiac trunk Supply: Distal esophagus, lesser curvature of stomach Splenic artery: Runs to the left in a tortuous course along the upper border of pancreas and behind stomach. Branches Pancreatic branches(dorsal pancreatic, transverse, and greater pancreatic artery) Left gastroepiploic artery: along the greater curvature odstomach in the gastrosplenic omentum Short gastric arteries: 5-6 number, supply the fundus of stomach in gastrosplenic omentum Hepatic artery Branches: 1.Right gastric artery: along lesser curvature of stomach ad anastomoses with left gastric artery 2.Gastroduodenal artery: It divides into right gastroepiploic artery ( along greater curvature) and superior pancreaticoduodenal artery that descends between 2nd part of duodenum and head of pancreas. 3.Right and left hepatic arteries: enter porta hepatis. Right hepatic artery usually gives of cystic artery  Superior Mesenteric Artery Supplies cecum, appendix, ascending colon, proximal 2/3 of transverse colon Branches Inferior pancreaticoduodenal artery- supplies head of pancreas and duodenum Jejunal branches (5-6) Ileal branches (6-8) Ileo-colic artery Anterior caecal, posterior caecal and appendicular artery Right Colic artery- supplies ascending colon and right colic flexure Middle colic artery- supplies right 2/3 of transverse colon  Inferior Mesenteric Artery Supplies distal 1/3of transverse colon, left colic flexure, descending and sigmoid colons, rectum and upper half of anal canal. Branches Left colic artery: supplies distal /3 of transverse colon, left colic flexure and upper part of descending colon Sigmoid arteries: supply descending and sigmoid colon Superior rectal artery: supplies rectum and upper half of anal canal and anastomoses with middle rectal and inferior rectal arteries. Marginal artery of Drummond Single artery that formed by anastomosis of colic arteries around margins of large intestines. It anastomoses with ileal branch of superior mesenteric and superior rectal arteries.  Inferior Vena Cava Inferior Vena Cava It is formed by union of common iliac veins behind right common iliac artery at level of L5. Tributaries: 2 Anterior visceral tributaries: Right and left hepatic veins 3 Lateral visceral tributaries: right suprarenal vein, renal veins and right testicular/ovarian vein 5 Lateral abdominal wall tributaries: Inferior phrenic and 4 lumbar veins 3 Veins of origin: 2 common iliac veins and median sacral veins Venous drainage of GIT Venous drainage of most of GIT and its accessory organs is drained into liver by portal venous system.  Portal Vein It drains blood from abdominal part of GIT from lower third of esophagus to halfway down anal canal it also drains blood from spleen , pancreas and gallbladder. Portal is short and formed behind neck of pancreas by union of superior mesenteric and splenic veins. Tributaries of Portal Vein Splenic vein: begins at hilum of spleen by union of several veins and is joined by short gastric and left gastroepiploic veins. It unites with superior mesenteric vein behind neck of pancreas to form portal vein. Inferior mesenteric vein: ascend on posterior abdominal wall and joins splenic vein behind body of pancreas. It receives superior rectal veins, sigmoid veins and left colic veins Superior mesenteric vein: ascend in root of mesentery of small intestine. It passes infront of 3rd part of duodenum and joins splenic veins behind neck of pancreas. It receives jejunal, ileal, ileocolic, middle colic , inferior pancreaticoduodenal and right gastroepiploic veins. Left gastric vein: drains left portion of lesser curvature of stomach and distal part of esophagus. Right gastric vein: drains right portion of lesser curvature of stomach Cystic veins: either drains gallbladder directly into liver or join portal vein. BLOOD VESSELS Head and Neck Chest Abdomen Pelvic and Perineum Extremities  Pelvic Blood Vessels Four main arteries of the pelvis: Paired internal iliac arteries, which supply the pelvic viscera Paired gonadal arteries (testicular and ovarian), which supply the internal genitalia outside of the pelvic cavity (testis, epididymis; ovaries, uterine tubes) A single median sacral artery that supplies sacrum and coccyx A single superior rectal artery that supplies the rectum  Pelvic Blood Vessels Common iliac Source: abdominal aorta (at the level of L4) artery Branches: branches to ureter and peritoneum Terminal branches: external and internal iliac arteries External iliac Source: common iliac artery (at the level of sacroiliac artery joint) Branches: inferior epigastric artery, deep circumflex artery Terminal branch: femoral artery Supplies: anterior compartment of the thigh (femoral artery), iliac crest bone flap (deep circumflex artery), anterior abdominal wall (inferior epigastric artery) Internal iliac Source: common iliac artery (at the level of sacroiliac artery joint) Anterior branches: Obturator, Middle rectal, Superior vesical, Uterine (female), Inferior gluteal, Inferior vesical (male) or vaginal (female), internal Pudendal arteries Supplies: Psoas major muscle, quadratus lumborum, iliacus muscle, uterus, vagina, bladder, prostate, semicanal vesicle  Common iliac artery Abdominal aorta divides into right and left common iliac arteries at level of vertebrae disc between L4 and L5 Owing to the position of the aorta , the right common iliac artery is approximately 1 cm longer that the left and crosses directly in front of L5  External iliac artery Origin: Lateral bifurcation of common iliac , begins opposite the lumbosacral joint Course: Along the medial border of the psoas major and lateral pelvic side wall, become femoral artery after passing under the injuinal ligament to supply lower extremity Venous drainage: lie posterior and then medial to the artery as it enters the anterior thigh: drain into common iliac veins Branches of External Iliac artery 1.Superfical epigastric – supplies skin and subcutaneous tissue of lower anterior abdominal wall 2.External pundendal- supplies skin and subcutaneous tissue of mons pubis and anterior vulva 3.Superficial circumflex iliac- supplies skin and subcutaneous tissue of the flank 4.Inferior epigastric – supplies musculofascial layer of lower anterior abdominal wall 5.Deep circumflex iliac- supplies musculofascial layer of lower abdominal wall  Internal iliac artery Origin:medial bifurcation of common iliac artery , begins opposite the lumbosacral joint is major blood supply of pelvis Course: internal arteries are crossed anteriorly by the ureter as they enter the pelvis Arising anterior to the sacroiliac joint, The IIA continues to the level of upper margins of the greater sciatic notch , where they divide into anterior and posteiro division  Branches of Internal iliac artery 1.Umbilical artery sup vesical branches, which supply the sup aspect of the bladder , these vessels also giving branches to supply the distal end of ureter The distal end of the umbilical artery-the median umbilical ligament 2. Obturator artery It enters the obturator canal by passing forward on the lateral wall of the pelvis, 2-3 cm below the pelvic brim, to enter the obturator canal 3. Uterine artery It is the main blood supply to the uterus ( although the uterus also receives supply from the ovarian and internal pundendal arteries.  4. Vaginal artery- Supplies vagina 5.Middle rectal artery ( hemorrhoidal)-supplies the muscular wall of the lower part of rectum 6. Inferior vesical arteries- supplies fundus of bladder, as well as giving small branches to the distal part of ureter 7. Internal pundendal artery and inferior gluteal artery ( terminal branches of IIA)  internal pundendal artery The internal pundendal artery enters the perineum through the lesser sciatic foramen to enter the pundendal ( or Alcock’;s ) canal within the perineum It gives off branches to the muscles and nerves in the pelvic and gluteal regions. is the main artery of the perineum. inferior rectal artery branches from the internal pundendal artery at the start of the pundendal canal provides arterial supply to piriformis, iliococcygeus and ischiococcygeus muscles. BLOOD VESSELS Head and Neck Chest Abdomen Pelvic and Perineum Extremities  Blood vessels of Upper limb Arteries Shoulder: axillary artery and six branches (Superior thoracic, Thoracoacromial, Lateral thoracic, Anterior circumflex humeral, Posterior circumflex humeral, Subscapular arteries) Arm: brachial artery and four branches (profunda brachii artery, nutrient artery to humerus, superior ulnar collateral artery, inferior ulnar collateral artery) Forearm: - radial artery and its branches (radial recurrent artery, palmar carpal branch, superficial carpal branch) - ulnar artery and its branches (Anterior ulnar recurrent artery, Posterior ulnar recurrent, muscular arteries, Common interosseous artery, Dorsal carpal artery, Deep palmar artery, Palmar carpal arteries) Hand: superficial palmar and deep palmar arches, formed by the anastomosis of the radial and ulnar arteries Veins Shoulder: axillary vein Arm: brachial veins Forearm: basilic, cephalic and median forearm veins Hand: deep veins and superficial veins which form the dorsal venous networK Arteries of Upper limb  Subclavian Artery Origin Left subclavian artery: Aortic arch Right subclavian artery: Brachiocephalic trunk Branches Vertebral artery Internal thoracic artery Thyrocervical trunk Costocervical trunk Dorsal scapular artery Supply Upper limbs, thorax, neck region, brain  Axillary Artery Source Subclavian artery Branches Superior thoracic, Thoracoacromial, Lateral thoracic, Anterior circumflex humeral, Posterior circumflex humeral, Subscapular Vein The axillary vein Supplies The axilla, upper limb, lateral thoracic region Axillary Axillary Artery Artery  Brachial Artery Source Axillary artery Branches Deep brachial artery Superior ulnar collateral artery Inferior ulnar collateral artery Radial artery Ulnar artery Vein Brachial vein Supplies Biceps brachii, triceps brachii, coracobrachialis muscles Radial and Ulnar arteries  Arterial Arches of Palm Radial and Ulnar arteries anastomose in the hand by forming two arches- The superficial palmar arch deep palmar arch  Veins of Upper Limb Classification Superficial and deep veins Veins of the Superficial veins: Basilic vein, cephalic vein arm and axilla Deep veins: Brachial veins, axillary vein, subclavian vein Veins of the Superficial veins: Basilic vein, cephalic vein forearm Deep veins: Anterior and posterior interosseous veins, ulnar veins, radial veins Veins of the Superficial veins: Dorsal digital veins, palmar hand digital veins, dorsal venous network Deep veins: Superficial venous palmar arch, deep venous palmar arch, dorsal metacarpal veins, palmar metacarpal veins Superficial Vein  Superficial Vein The cephalic vein arises from the radial aspect of the dorsal venous network within the anatomical snuff box of the hand the basilic vein arises from the dorsal venous network of the hand but from the ulnar aspect, ascending posteromedially within the forearm. The basilic vein continues into the arm and unites with the brachial veins to form the axillary vein.  Deep Vein radial and ulnar veins are the main deep veins of the forearm. They are typically made up of two veins each which accompany the radial and ulnar arteries (venae comitants). brachial vein is formed by the union of the radial and ulnar veins within the cubital fossa. At the inferior border of the teres major muscle, the brachial vein unites with the basilic vein to form the axillary vein. Blood Vessels of Lower Extremities  Blood Vessels of Lower Extremities Femoral artery It is the largest artery that brings oxygenated blood to the entire lower extremity. Branches include: superficial epigastric artery, superficial circumflex iliac artery, superficial external pudendal artery, deep external pudendal artery, deep femoral artery, descending genicular artery Arteries Hip and thigh: femoral, gluteal (superior, inferior), obturator, deep femoral, descending genicular arteries Knee and leg: popliteal, superior genicular (medial, lateral), inferior genicular (medial, lateral), tibial (anterior, posterior), anterior malleolar (medial, lateral), fibular/peroneal arteries Ankle and foot: malleolar (anterior, posterior) arteries, dorsalis pedis artery/dorsal artery of the foot, plantar arteries (medial, lateral), tarsal arteries (medial, lateral), arcuate artery, dorsal metatarsal arteries, deep plantar arch, plantar metatarsal arteries Veins Superficial venous system: superficial dorsal network, plantar venous networks, marginal veins, metatarsal veins -> small/short saphenous vein -> popliteal vein and great/long saphenous vein - > femoral vein Deep venous system: digital veins, metatarsal veins -> deep plantar and dorsal venous arches -> tibial (anterior, posterior) and fibular veins -> popliteal vein -> femoral vein  Femoral artery Source External iliac artery Branches Descending genicular artery, Profunda femoris artery, Superficial epigastric, Superficial circumflex iliac, Superficial external pudendal, Deep external pudendal arteries Continuation Popliteal artery Vein Femoral vein Supplies Anterior compartment of the thigh Arteries of Lower Limb-Thigh  Popliteal artery Source Femoral artery Branches Anterior tibial artery Posterior tibial artery Sural artery Superior lateral genicular artery Superior medial genicular artery Middle genicular artery Inferior lateral genicular artery Inferior medial genicular artery Supplies Knee joint, leg muscles  Arteries of Lower Limb –Leg Posterior Tibial artery- continues inferiorly , along the surface of deep posterior leg (such as tibialis posterior) Fibular ( peroneal artery)- descended posterior to the fibula, within posterior compartment of leg.  Dorsalis pedis artery Origin Anterior tibial artery Branches Lateral tarsal artery, medial tarsal arteries, arcuate artery, and first dorsal metatarsal artery Supply Tarsal bones, tarsal joints, tarsometatarsal joints, metatarsal bones, intermetatarsal joints, metatarsophalangeal joints, extensor digitorum brevis muscle, extensor hallucis brevis muscle, dorsal interossei muscles, digital extensor tendons, interdigital clefts, proximal and middle phalanges of toes, skin and fascia of the dorsum Veins of Lower Limb  Greater Saphenous vein Origin Medial marginal vein of foot Tributaries Small saphenous, accessory saphenous, anterior femoral cutaneous, superficial epigastric, superficial circumflex iliac, superficial external pudendal veins Drains to Femoral vein  Lesser Saphenous vein Source Lateral marginal vein of the foot Tributaries Deep veins of the dorsum of the foot Cutaneous veins of the leg Drains to Popliteal vein  Deep vein Present within the deep fascia surrounded by powerful muscles. Blood flow in greater pressure and volume Accounts for 80-90% venous return  Deep vein Deep Veins of the foot veins - plantar veins - dorsal veins Veins of the leg - anterior tibial veins - posterior tibial veins - fibular veins Veins of the knee - popliteal vein Veins of the thigh - femoral vein and its tributaries  Perforators Communicate superficial vein to deep vein BLOOD VESSELS Head and Neck Chest Abdomen Pelvic and Perineum Extremities