Major Arteries and Veins of the Limbs PDF

MAJOR ARTERIES AND VEINS OF THE LIMBS Main arteries & their surface anatomy Vessels of the Sites of palpation of main Upper Limb pulses Important arterial anastomoses Main venous channels & their surface anatomy Clinically applied anatomy – sites of comp...

MAJOR ARTERIES AND VEINS OF THE LIMBS Main arteries & their surface anatomy Vessels of the Sites of palpation of main Upper Limb pulses Important arterial anastomoses Main venous channels & their surface anatomy Clinically applied anatomy – sites of compression, common arterial lacerations & consequences, ischemia, palmar wounds, injuries to veins, venepuncture & venous catheterisation Artery surrounded by the axillary sheath and cords & Axillary Artery branches of the brachial plexus Important anastomoses – 1-anterior & posterior circumflex humeral arteries around the surgical neck and scapular anastomoses-2 between the subclavian & axillary artery Axillary vein lies medial Axillary Vein to the neurovascular bundle and outside the axillary sheath – able to dilate when blood flow increases Axillary vein is the continuation of the basilic & brachial veins Axillary vein wounds – risk of air emboli  Brachial Artery & Veins in the Cubital Fossa Continuation of the axillary artery & ends in the cubital fossa by dividing into radial & ulnar arteries. Artery supplies muscles of the arm, the elbow joint & the humerus Artery gives off profunda brachii artery which runs in the spiral (radial) groove with the radial nerve. Palpable through its course in the arm & in the cubital fossa lying medial to the biceps tendon under the bicipital aponeurosis – usual site for taking BP Median cubital vein lies superficial to the aponeurosis; vein used for venepuncture Elbow fracture displacement may lacerate or occlude the brachial artery & cause ischemia & paralysis of forearm muscles (Volkmann’s ischemic contracture) Median nerve lies medial to Brachial Artery in it; both lying underneath the Elbow region the bicipital aponeurosis Brachial, radial and ulnar arteries form the anastomosis around the elbow joint; blockage of the brachial artery in the elbow region proximal to origin of radial & ulnar arteries may result in blood reaching distal structures via the connecting vessels Radial artery arises from the Radial Artery in brachial artery in the cubital fossa at the level of the neck of the the Forearm radius Runs on the lateral aspect of the forearm and passes over to the dorsum of the hand Palpable at the wrist in front of the radius between tendons of flexor carpi radialis and brachioradialis; also palpable against the scaphoid in the anatomical snuff box Vulnerable to injury in wrist lacerations Ulnar artery arises from the Ulnar Artery in brachial artery in the cubital fossa the Forearm ; gives off common interosseous artery to supply the forearm muscles via its anterior and posterior interosseous branches Runs on the medial side of forearm with the ulnar nerve underneath flexor carpi ulnaris Palpable at the wrist where it passes in front of the flexor retinaculum Vulnerable to injury in wrist lacerations Ulnar artery forms the superficial palmar arch deep to the palmar Arteries in the aponeurosis. Gives of 4 palmar digital Palm of the Hand arteries that bifurcate to supply the adjacent sides of the fingers Gives off the a deep branch which forms an anastomosis with the deep palmar arch. Deep plamar arch is formed largely by the radial artery and lies deep to the long flexor tendons; supplies deeper structures. Radial artery forms an anastomosis with the superficial palmar arch via its superficial branch in front of the wrist Palmar arches not palpable but their location should be borne in mind in palmar injuries and when incisions are made Occur in superficial & deep groups that communicate via perforating veins Veins of the Superficial group - Dorsal venous arch on the Upper Limb dorsum of the hand; from its lateral side arises the cephalic vein & basilic vein arises from its medial side Cephalic vein ascends on the radial side of the forearm, crosses the cubital fossa, lies on the lateral side of the biceps and enters the axillary vein in the upper aspect of the arm (via the delto-pectoral fascia) Basilic vein ascends on the ulnar side of the forearm, cross the cubital fossa, lies medial to the biceps and pierces the deep fascia of the arm to join brachial veins (deep group) Deep group – veins that accompany major arteries in the forearm join in the cubital fossa to form the brachial veins. Brachial veins & basilic vein form the axillary vein. Veins in the forearm and hand are most frequently chosen for intravenous infusions; e.g. cephalic vein near the wrist MAJOR ARTERIES AND VEINS OF THE LOWER LIMBS  Femoral Vessels Other major arterial branches – medial & lateral circumflex femoral – supply the hip.joint Femoral vein – continuation of the.popliteal vein lies medial to the artery Femoral Vein easily accessible; frequently used for venous access in shocked patients.with low blood pressure & collapsed veins Great saphenous vein, draining the skin & subcutaneous tissue of the leg & thigh passes through the saphenous opening to.enter the femoral vein Popliteal artery – continuation of the femoral artery passes through the Popliteal popliteal fossa and bifurcates at the Vessels lower border of popliteus into anterior & posterior tibial arteries Popliteal vein & tibial nerve lie superficial to artery; popliteal pulse is Perforating not palpable easily – palpable with the branches of profunda knee flexed femoris Genicular anastomoses around the knee form an important collateral circulation.Genicul for bypassing the main popliteal vessel to.Anast reach the distally when the knee is in flexion for a long period or when the popliteal vessel is narrowed or occluded  POPLITEAL VESSELS Popliteal aneurysm usually causes oedema and pain in the popliteal fossa Popliteal vein – formed by the union of anterior and posterior tibial veins – is entered by the small saphenous vein through the facial roof of the popliteal fossa Vessels of the Leg Popliteal artery divides into VESSELS OF anterior and posterior tibial arteries THE LEG Anterior tibial artery passes Popliteal artery over the interosseous membrane Popliteus Anterior.tibial art muscle into the anterior compartment of the leg to supply the extensor Posterior.tibial art Peroneal (dorsiflexor) muscles (fibular) artery Posterior tibial artery continues into the posterior compartment (calf) of the leg to supply the flexors Peroneal (fibular) artery from Vessels of the posterior tibial supplies the lateral compartment of the leg the Leg Deep veins (venae commitantes) Popliteal artery accompany the anterior & Popliteus Anterior.tibial art muscle posterior tibial vessels and drain into the popliteal vein Posterior.tibial art Peroneal Communicating (perforating) (fibular) artery veins connect the veins in the superficial fascia below the skin with the deep veins Anterior tibial artery Vessels of the becomes superficial at the Foot ankle as the dorsalis pedis artery on the dorsum of the foot Dorsalis pedis pulsations can be felt between the tendon of extensor hallucis longus and the most medial tendon of extensor digitorum longus Posterior tibial artery Vessels of passes behind the medial the Foot malleolus and enters the foot where it divides into lateral an medial plantar arteries Posterior tibial pulsations can be palpated midway between the medial malleolus and calcaneum Three 3 types – superficial, deep & communicating (perforating) Veins of the Valves in larger veins & in communicating veins; direct blood flow towards the heart or Lower Limb from the superficial to the deep veins Superficial veins (long & short saphenous)-1 drain skin & superficial fascia; originate in the foot (dorsal & plantar venous arches) Long (great) saphenous vein begins from the medial side of the dorsal arch, ascends anterior to the medial malleolus along the medial side of the leg; at the knee it is 4 SS fingers breadth medial to the patella; enters LS the femoral vein by passing through the saphenous opening; communicates with the deep veins of the thigh and the calf via ’‘perforators Short (small) saphenous VEINS OF THE begins from the lateral side LOWER LIMB of the dorsal arch, ascends posterior to the lateral malleolus up the posterior calf & enters the popliteal vein; communicates with the deep veins of the calf via ’‘perforators LS SS Deep veins comprise of -2 venae commitantes of deep arteries  Venous Blood Flow of the Lower Limb Veins permit blood flow up the limb, or from the superficial to the deep Flow towards the heart is aided by the ‘muscle pump’; pressure from contracting foot and calf muscles forces blood in the deep veins up the limb towards the femoral vein If the valves in the communicating veins become incompetent, blood flow within them is reversed; blood is forced into the superficial veins which become distended (varicose veins) because of their thin walls and the nature of the supportive tissue around them  Venous Blood Flow of the Lower Limb In prolonged lying down activity when muscle activity is minimal, stagnation of blood occurs in the deep veins that may lead to deep vein thrombosis (DVT); risk of pulmonary thrombus Defective valves in the superficial veins causes pooling of stagnant blood in the superficial fascia with a risk of skin changes & skin ulceration Defective venous return from the lower limb results in chronic leg swelling (oedema), particularly.around the ankle Just anterior & superior to the Clinical medial malleolus is constant site for emergency venous Perspectives ‘cutdown’; care is taken not to injure the saphenous nerve (sensory branch of the Femoral.nerve) Long saphenous vein is commonly used in blood vessel grafts to replace parts of blocked coronary arteries; the venous graft is reversed so as.not to obstruct flow Valves in the Long (Great) Saphenous vein Thank you