Vascular System, Part I, Arteries PDF

 RSU Institute of Anatomy and Anthropology Vascular system, part I, arteries 1 BLOOD VESSELS OF PULMONARY CIRCULATION The pulmonary circulation circulus sanguinis minor serves for the exchange of gases. For the pulmonary circulation the deoxygenated blood from th...

 RSU Institute of Anatomy and Anthropology Vascular system, part I, arteries 1 BLOOD VESSELS OF PULMONARY CIRCULATION The pulmonary circulation circulus sanguinis minor serves for the exchange of gases. For the pulmonary circulation the deoxygenated blood from the right ventricle is pumped into truncus pulmonalis and then via the pulmonary arteries a. pulmonalis dextra et sinistra into the capillary networks of the lungs. From the lungs oxygenated blood flows back via venae pulmonales (4) into the left atrium. Truncus pulmonalis starts from ventriculus dexter behind art. sternoclavicularis sinistra; it is about 5 cm long and 3 cm in diameter. On the right side and behind it lies aorta ascendens, on the left side – auricula sinistra. Truncus pulmonalis runs upward and to the left; it divides into a. pulmonalis dextra et sinistra below arcus aortae. The place of division is called bifurcatio trunci pulmonalis. Between this bifurcation and the lower part of arcus aortae is lig. arteriosum (before the birth it is ductus arteriosus Botalli). A. pulmonalis dextra runs to the right side behind aorta ascendens and vena cava superior to hilum pulmonis, where it divides into arteries for the lobes (3) and segments. A. pulmonalis sinistra is shorter and smaller in diameter than the right one. In hilum pulmonis it divides into arteries for the lobes (2) and segments. Venae pulmonales There are two venae pulmonales on each side formed by the capillary networks and venules of the lungs. Venae pulmonales leave the lung via hilum pulmonis. BLOOD VESSELS OF SYSTEMIC CIRCULATION The systemic circulation – circulus sanguinis major supplies blood to all the organs. The oxygenated blood from the left ventricle is pumped into aorta and then via arteries into the capillary networks of the organs. The deoxygenated blood is returned into the right atrium from the lower extremities and the lower part of the trunk via vena cava inferior and from the head and neck, the upper limbs and the upper part of the trunk via vena cava superior. AORTA Aorta is the main trunk of the arterial vessels, which convey the oxygenated blood to the tissue of the body for their nutrition. It ascends behind truncus pulmonalis to the right, then forms an arch and passes backward and to the left. The aorta descends from the 4th thoracic vertebra and lies at first to the left and then in front of the vertebral column. In the thoracic region the aorta is crossed by the oesophagus. Then the aorta passes through hiatus aorticus into the abdominal cavity. In front of the 4th lumbar vertebra it divides into a. iliaca communis dextra et sinistra. The unpaired continuation of aorta is a. sacralis mediana – the remnant of a tail artery. Topographycally the aorta is divided into three parts: 1. aorta ascendens; 2. arcus aortae; 3. aorta descendens: a) aorta thoracica – the part of aorta descendens in thoracic cavity, b) aorta abdominalis – the part of aorta descendens in abdominal cavity. AORTA ASCENDENS Aorta ascendens is about 5 cm in lenght. It originates by ostium aortae at the upper part of ventriculus sinister at the level of the 3rd left rib behind sternum. There is a dilatation 2 RSU Institute of Anatomy and Anthropology Vascular system, part I, arteries – bulbus aortae at the origin place, what is formed by three sinus aortae. Aorta ascendens curves obliquely upward, anteriorly and to the right as high as the upper border of the 2nd right costal cartilage and then continues into arcus aortae. Aorta ascendens is surrounded by pericardium. To the right from it lies v. cava superior, to the left and anteriorly – truncus pulmonalis, posteriorly – a. pulmonalis dextra, vv. pulmonales dextrae, bronchus principalis dexter. At the level of sinus aortae the ascending aorta has two side branches: a. coronaria dextra and a. coronaria sinistra. ARTERIES OF THE HEART AA. CORONARIAE A. coronaria dextra arises from the ascending aorta at the level of sinus aortae. It passes to the right and lies in sulcus coronarius, curves around margo dexter cordis to facies diaphragmatica, then passes from the right side to the left and descends along sulcus interventricularis posterior as r. interventricularis posterior to apex cordis. At the coronary groove it communicates with r. circumflexus. A. coronaria dextra supplies: – the right atrium and septum interatriale, – the posterior wall and part of the anterior wall of the right ventricle, – the posterior third of septum interventriculare, – mm. papillares of the right ventricle, m. papillaris posterior of the left ventricle, – part of the posterior wall of the left ventricle, – nodus sinuatrialis, nodus atrioventricularis. A. coronaria sinistra arises from the ascending aorta at the level of sinus aortae and divides into two branches: 1. r. interventricularis anterior descends along sulcus interventricularis anterior to apex cordis, where it communicates with r. interventricularis posterior (a. coronaria dextra); 2. r. circumflexus runs along sulcus coronarius at first to the left around facies pulmonalis, then to the right as far as sulcus interventricularis posterior and communicates with a. coronaria dextra. Because of anastomoses of both coronary arteries there are two arterial circles – horizontal one along sulcus coronarius and oblique one along sulcus interventricularis anterior et posterior. A. coronaria sinistra supplies: – the left atrium, – the left ventricle (except a small part of the posterior wall), – part of the anterior wall of the right ventricle, – the two anterior thirds of septum interventriculare, – m. papillaris anterior of the left ventricle, – fasciculus atrioventricularis. ARCUS AORTAE Arcus aortae is the continuation of aorta ascendens. It begins at the level of the 2nd right sternocostal junction, runs upward, backward and to the left, then passes downward and at the level of the 4th thoracic vertebra becomes continuation of aorta descendens. Anteriorly to arcus aortae lies thymus (for children) or remnants of thymus (for adults), posteriorly – bifurcatio tracheae, above – v. brachiocephalica sinistra, below – truncus pulmonalis division into a. pulmonalis dextra et sinistra. From the lower surface of the aortic arch arise small branches for supplying adjacent organs – rr. tracheales et rr. bronchiales. From the upper surface of arcus aortae start three blood vessels: – truncus brachiocephalicus,  RSU Institute of Anatomy and Anthropology Vascular system, part I, arteries 3 – a. carotis communis sinistra, – a. subclavia sinistra. TRUNCUS BRACHIOCEPHALICUS Truncus brachiocephalicus is the largest branch of arcus aortae, it has lenght about 2 – 3 cm. The trunk ascends obliquely upward, backward and to the right; at the level of right sternoclavicular joint it divides into: a. carotis communis dextra and a. subclavia dextra. ARTERIES OF THE HEAD AND NECK A. CAROTIS COMMUNIS A. carotis communis is a major source of blood supply for the head and neck. The common carotid arteries differ in lenght and in mode of origin. The right one begins at the bifurcation of truncus brachiocephalicus behind the right sternoclavicular joint and is shorter. The left one is direct artery of the aortic arch, it ascends in mediastinum superius to the level of left sternoclavicular joint. The common carotid artery leaves the thoracic cavity through superior thoracic aperture and ascends in composition of a bunch of nerves and blood vessels. The bunch is formed by ansa cervicalis anteriorly, n. vagus – posteriorly, v. jugularis interna – laterally and a. carotis communis – medially. Fascia surrounds the bunch and forms vagina carotica. The bunch lies on deep muscles of the neck; anteriorly it is covered by m. sternocleidomastoideus, platysma and crossed by m. omohyoideus. A. carotis communis passes upward through the neck without branching; it can be compressed against tuberculum caroticum of the 6th cervical vertebra. At the level of the upper border of the thyroid cartilage it divides into the external and internal carotid arteries: a. carotis externa and a. carotis interna. There is a structure containing hemoreceptors – glomus caroticum – at the place of division of a. carotis communis. This formation perceives chemical changes of the blood. Beginning part of a. carotis interna has a dilatation – sinus caroticus – receptors of which could influence the blood pressure and the heart rate. A. CAROTIS EXTERNA A. carotis externa originates at the upper border of the thyroid cartilage and is placed in trigonum caroticum. It passes upward and forward, is covered by platysma and lamina superficialis fasciae cervicalis. Then a. carotis externa inclines backward and lies behind m. stylohyoideus and venter posterior m. digastrici. Then the artery passes through the substance of the parotid gland, ascends to fossa retromandibularis and behind collum mandibulae divides into two terminal branches: – a. maxillaris, – a. temporalis superficialis. The side branches of a. carotis externa could be arranged into three groups: – anterior group: a. thyroidea superior, a. lingualis, a. facialis, – medial group: a. pharyngea ascendens, – posterior group: a. occipitalis, a. auricularis posterior. The anterior group of the side branches of a. carotis externa: A. thyroidea superior begins at the level of os hyoideum, arches downward and terminates in glandula thyroidea. It gives off a. laryngea superior, which accompanies n. 4 RSU Institute of Anatomy and Anthropology Vascular system, part I, arteries laryngeus superior and supplies muscles of the larynx. A. thyroidea superior also supplies straight muscles of the neck angl below os hyoideum; A. lingualis arises at the level of os hyoideum, passes between muscles of the tongue and finishes as a. profunda linguae. A. lingualis supplies the tongue and has branches: rr. dorsales linguae supply mucous of dorsum linguae, a. sublingualis supplies gl. sublingualis and mucosa of the floor of the mouth; A. facialis arises from a. carotis externa at the level of angulus mandibulae, then passes through trigonum submandibulare close to the submandibular gland. Artery curves around basis mandibulae at the anterior margin of m. masseter. In this place the pulse of artery could be felt. Then it directs to angulus oris, ascends along the side of the nose and terminates at the medial corner of the eye as a. angularis, which communicates with a. dorsalis nasi (a. ophthalmica). A. facialis along its course gives off side branches: a) rr. glandulares – they supply gl. submandibularis, b) a. palatina ascendens – it passes along the side of the pharynx and reaches the palate. The artery supplies palatum molle and anastomoses whith a. palatina descendens, c) rr. tonsillares – they supply tonsilla palatina, d) a. submentalis – it supplies inferior surface of the floor of the mouth and glandula submandibularis, e) a. labialis inferior, f) a. labialis superior. The last two arteries supply the upper and lower lips; they have anastomoses with arteries from the opposite side and form a circle of arteries. The medial group of the side branches of a. carotis externa: A. pharyngea ascendens ascends along the lateral wall of the pharynx to basis cranii externa, enters the cranial cavity through foramen jugulare and terminates in fossa cranii posterior as a. meningea posterior to supply meninges in fossa cranii posterior. It gives off branches: rr. pharyngei supply wall of the pharynx and deep muscles of the neck, a. tympanica inferior passes through canaliculus tympanicus to the tympanic cavity and supplies it. The posterior group of the side branches of a. carotis externa: A. occipitalis starts at the level of the lower margin of venter posterior m. digastrici, runs posteriorly, lies in sulcus arteriae occipitalis and supplies the occipital region. A. occipitalis gives side branch r. mastoideus, which passes through foramen mastoideum to fossa cranii posterior and supplies the meninges; and rr. sternocleidomastoidei, which supply m. sternocleidomastoideus; A. auricularis posterior originates at the level of the upper margin of venter posterior m. digastrici, ascends behind auricula to the occipital region and terminates by rr. auriculares. The artery supplies auricula and the posterior part of the temporal region. The artery has a side branch a. stylomastoidea, which enters canalis nervi facialis through foramen stylomastoideum. The artery supplies mucous membrane of cellulae mastoideae and gives off a. tympanica posterior, which through canaliculus chordae tympani runs to the tympanic cavity and supplies mucous membrane of it. The terminal branches of a. carotis externa A. temporalis superficialis A. temporalis superficialis starts from a. carotis externa at the level of collum mandibulae. It ascends in front of auricula, crosses arcus zygomaticus and at the level of margo supraorbitalis divides into the terminal branches: r. frontalis – it supplies the frontal region and communicates with branches of a. ophthalmica,  RSU Institute of Anatomy and Anthropology Vascular system, part I, arteries 5 r. parietalis – it supplies the parietal region and communicates with branches of a. auricularis posterior and a. occipitalis. A. temporalis superficialis along its course gives off side branches: rr. auriculares anteriores to supply auris externa, a. transversa faciei for skin and mimetic muscles of the lateral region of the face, r. parotideus for glandula parotidea, and a. temporalis media to supply m. temporalis. A. maxillaris A. maxillaris arises from a. carotis externa behind collum mandibulae and is imbedded in the substance of the parotid gland. Then it passes through fossa infratemporalis and fissura pterygomaxillaris to fossa pterygopalatina and divides into the terminal branches. Topographycally a. maxillaris could be divided into three parts: – the pathway around the temporomandibular joint, – the pathway through fossa infratemporalis, – the pathway through fossa pterygopalatina. The pathway of a. maxillaris around the temporomandibular joint is behind collum mandibulae and has 4 side branches: A. auricularis profunda supplies meatus acusticus externus, membrana tympanica and art. temporomandibularis; A. tympanica anterior enters the tympanic cavity through fissura petrotympanica and supplies it; A. meningea media is the largest branch of this part of a. maxillaris; it ascends and enters the cranial cavity through foramen spinosum and supplies dura mater in fossa cranii media and in the calvaria region. This artery gives small branch a. tympanica superior, which enters the tympanic cavity to supply it through hiatus canalis nervi petrosi minoris; A. alveolaris inferior passes along canalis mandibulae together with n. alveolaris inferior, emerges through foramen mentale as r. mentalis and supplies skin and muscles of the chin. A. alveolaris inferior side branches: rr. dentales – for the lower teeth, rr. peridentales – supply the gums, r. mylohyoideus – supplies m. mylohyoideus and venter anterior m. digastrici. The pathway of a. maxillaris through fossa infratemporalis is between m. pterygoideus medialis et lateralis. It gives off branches: A. masseterica – supplies m. masseter; Aa. temporales profundae (anterior et posterior) – supply m. temporalis; Rr. pterygoidei – supply mm. pterygoidei; A. buccalis – supplies m. buccinator. The pathway of a. maxillaris through fossa pterygopalatina gives 4 branches: Aa. alveolares superiores posteriores – they return into fossa infratemporalis via fissura pterygomaxillaris and descend along tuber maxillae, run through foramina alveolaria et canales alveolares, then divide into numerous terminal branches rr. dentales et rr. peridentales to supply upper molar and premolar teeth, the gums and sinus maxillaris; A. infraorbitalis runs to the optic cavity through fissura orbitalis inferior, lies in sulcus et canalis infraorbitalis, appears on the anterior region of the face through foramen infraorbitale. The artery supplies the anterior region of the face (the skin and muscles). In the canal it gives off side branches aa. alveolares superiores anteriores to supply the upper incisors, canine teeth and sinus maxillaris; they terminate as rr. dentales et rr. peridentales; A. palatina descendens passes through canalis palatinus major to the lower surface of the palate. The artery supplies the gums, the soft and hard palate. A. canalis pterygoidei courses through canalis pterygoideus and supplies tuba auditiva et nasopharynx; A. sphenopalatina passes through foramen sphenopalatinum to supply posterior part 6 RSU Institute of Anatomy and Anthropology Vascular system, part I, arteries of the nasal cavity and the mucous membrane of sinus sphenoidalis. Its terminal branch a. nasopalatina descends through canalis incisivus to the oral cavity and communicates with a. palatina descendens. The artery assists in blood supplying of the palate. A. CAROTIS INTERNA The internal carotid artery originates at the upper border of the thyroid cartilage and has four parts: pars cervicalis, pars petrosa, pars cavernosa, pars cerebralis. The artery passes upward to the base of the skull, then runs trought canalis caroticus. In the canal it gives rr. caroticotympanici to supply the tympanic cavity. After it enters fossa cranii media, passes in composition of sinus cavernosus. Then the artery leaves sinus cavernosus at the level of processus clinoideus anterior and divides into the terminal branches: a. ophthalmica, a. cerebri anterior, a. cerebri media, a. communicans posterior, a. choroidea anterior. A. ophthalmica A. ophthalmica enters the optic cavity through canalis opticus and is placed laterally to n. opticus. The artery crosses the nerve and passes along the medial wall of the optic cavity to the medial corner of the eye, where it terminates as a. dorsalis nasi. A. dorsalis nasi communicates with a. angularis (a. facialis). A. ophthalmica side branches could be divided into two groups. The branches arising in the optic cavity: A. centralis retinae runs in the composition of n. opticus and supplies retina, Aa. ciliares posteriores longae et breves supply tunica vasculosa bulbi, take part in formation of circulus arteriosus iridis minor et major, give branches to the sclera, Aa. musculares supply muscles of the eye. From they start aa. ciliares anteriores, which participate in formation of circulus arteriosus iridis minor et major, give branches to the sclera and conjunctiva, A. lacrimalis runs along the lateral wall of the optic cavity to supply glandula lacrimalis. It gives aa. palpebrales laterales to supply lateral part of the eyelids, Aa. palpebrales mediales supply medial part of the eyelids.Aa. palpebrales mediales et laterales together form arcus palpebralis superior et inferior. The branches arising outside the optic cavity: A. supraorbitalis passes through incisura (foramen supraorbitale) supraorbitalis and supplies skin and muscles in the region of the forehead; it anastomoses with r. frontalis (a. temporalis superficialis), A. supratrochlearis passes through incisura frontalis (foramen frontale) to supply skin and muscles of the forehead, A. ethmoidalis anterior runs through foramen ethmoidale anterius to fossa cranii anterior and gives off branch a. meningea anterior for the meninges in fossa cranii anterior. Then the artery descends through foramina cribrosa to the nasal cavity to supply sinus frontalis, cellulae ethmoidales and mucous membrane of the nasal cavity, A. ethmoidalis posterior passes through foramen ethmoidale posterius and supplies cellulae ethmoidales and mucous membrane of the nasal cavity.  RSU Institute of Anatomy and Anthropology Vascular system, part I, arteries 7 Arteries of the brain Arteries of the brain are arising from two main arteries: a. carotis interna and a. basilaris (a. vertebralis). Interconections of the branches of these arteries form a cerebral arterial circle – circulus arteriosus cerebri s. Willisi. It is located on the base of the brain around the hypothalamus region for the blood supplying of the brain. Circulus arteriosus cerebri: 1. a. communicans anterior, 2. a. cerebri anterior dx. et sin., 3. a. carotis interna dx. et sin., 4. a. communicans posterior dx. et sin., 5. a. cerebri posterior dx. et sin., 6. a. basilaris (division place). A. cerebri anterior Artery runs along fissura longitudinalis cerebri, curves around genu corporis callosi and passes backward till sulcus parietooccipitalis. In the beginning part there is a. communicans anterior, which communicates a. cerebri anterior of the both sides. A. cerebri anterior supplies lobus frontalis et parietalis on the medial surface, gyrus frontalis superior, lobulus parietalis superior and the upper parts of gyrus precentralis et postcentralis on the superolateral surface, gyrus rectus on the inferior surface. A. cerebri media It is the immediate continuation of the internal carotid artery; it runs along sulcus lateralis cerebri backward and laterally. It supplies insula, nucleus lentiformis, nucleus caudatus, capsula interna, gyrus frontalis inferior et medius, lower parts of gyrus precentralis et postcentralis, lobulus parietalis inferior, lobus temporalis (except gyrus temporalis inferior). A. communicans posterior Artery runs backward along sella turcica and communicates with a. cerebri posterior (a. basilaris). A. choroidea anterior enters the lateral ventricle and forms plexus choroideus ventriculi lateralis et tertii. It has branches for supplying substantia alba et grisea hemispherii cerebri. All arteries of the brain have branches arranged into three groups: a) for the cerebral cortex, b) for the white matter of the brain, c) for nuclei cerebri. A. SUBCLAVIA It has assymetrical commencement. On the right side a. subclavia arises from truncus brachiocephalicus behind the right sternoclavicular joint; on the left side – directly from arcus aortae. The left artery is about 4 cm longer than the right one. The artery leaves the thoracic cavity via superior thoracic aperture, curves over cupula pleurae and runs between m. scalenus anterior and m. scalenus medius. It lies on 1st rib in sulcus arteriae subclaviae and at the external margin of it continues into a. axillaris. Topographycally a. subclavia could be divided into three parts: 1) the first part – from the origin of the vessel to the medial border of m. scalenus anterior, 2) the second part – behind m. scalenus anterior, 3) the third part – from the lateral border of the muscle to the outer border of the first rib, where it becomes the axillary artery. 8 RSU Institute of Anatomy and Anthropology Vascular system, part I, arteries From the origin of the vessel to the medial border of m. scalenus anterior the subclavian artery gives three branches: a. vertebralis, a. thoracica interna, truncus thyrocervicalis. A. vertebralis It ascends through foramina transversaria of the cervical vertebras (from the 6th to the 1st), then it lies on sulcus arteriae vertebralis atlantis, penetrates membrana atlantooccipitalis posterior, through foramen magnum enters fossa cranii posterior. A. vertebralis has three parts: pars prevertebralis, pars transversalia, pars intracranialis. In the skull the artery lies on the clivus and at the lower border of the pons unites with the artery of the opposite side to form a. basilaris. A. basilaris lies on the pons and at the upper border of it terminates by division into two branches – a. cerebri posterior dx. et sin. A. cerebri posterior supplies lobus occipitalis, gyrus temporalis inferior on the superolateral surface, lobus temporalis on the inferior surface. Branches of pars transversalia: Rr. spinales supply the spinal cord, Rr. musculares supply deep muscles of the neck. Branches of pars intracranialis: A. spinalis anterior arises in the cranial cavity and goes into the vertebral canal. At the level of foramen magnum arteries of both sides join to form a single artery, which descends along fissura mediana anterior and supplies the spinal cord, A. spinalis posterior descends in the vertebral canal along sulcus posterolateralis of the spinal cord and supplies it, A. inferior posterior cerebelli arises in the cranial cavity, winds backward around medulla oblongata to the lower surface of the cerebellum and supplies it, Rr. meningei supply bones and falx cerebelli in fossa crania posterior. Branches of a. basilaris: A. inferior anterior cerebelli supplies the anterior part of the lower surface of cerebellum, Aa. labyrinthi runs through porus et meatus acusticus internus to the internal ear, Aa. pontis supply the pons, Aa. mesencephalicae supply mesencephalon, A. superior cerebelli supplies upper surface of the cerebellum. A. thoracica interna Artery arises from the lower side of the subclavian artery, descends along the internal surface of the anterior wall of the thoracic cavity behind the cartilages of the upper six ribs in the distance about 1,5 cm from the margin of the sternum. At the level of the 7th rib the artery divides into two terminal branches: a. epigatrica superior and a. musculophrenica. A. epigastrica superior continues into lower direction, penetrates the diaphragm in trigonum sternocostale, enters vagina m. recti abdominis; at the level of the umbilicus it communicates with a. epigastrica inferior (a. iliaca externa) and supplies m. rectus abdominis, vagina m. recti abdominis; A. musculophrenica makes its way obliquely downward and laterally, penetrates the diaphragm and terminates at the lower 5 – 6 intercostal spaces by rr. intercostales anteriores. The branches supply wall of the thoracic cavity and has communications with aa. intercostales posteriores (aorta thoracica).  RSU Institute of Anatomy and Anthropology Vascular system, part I, arteries 9 A. thoracica interna side branches: A. pericardiacophrenica starts at the level of the 1st rib, accompanies n. phrenicus, descends between the pleura and the pericardium in mediastinum medium in front of radix pulmonis. It supplies pars mediastinalis pleurae parietalis, pericardium, diaphragma, Rr. intercostales anteriores supply the upper 5 – 6 intercostal spaces. These branches communicate with aa. intercostales posteriores (aorta thoracica), Rr. perforantes give for female 2-3 branches to glandula mammae – rr. mammarii mediales, Rr. thymici – supply thymus, Rr. sternales – supply sternum, Rr. bronchiales – supply the lower part of the trachea and bronchus principalis, Rr. mediastinales – supply pleura mediastinalis and tissue of the mediastinum. Truncus thyrocervicalis It is a short trunk (1 – 3 cm) arising from a. subclavia medially to m. scalenus anterior and dividing into branches: A. thyroidea inferior passes upward, then medially and terminates in gl. thyroidea. It gives off a. laryngea inferior to supply muscles and mucous membrane of the larynx, rr. tracheales to supply the upper part of the trachea, rr. pharyngeales to supply the pharynx, rr. oesophageales to supply the upper part of the oesophagus; A. cervicalis ascendens goes upward along m. scalenus anterior and divides into rr. spinales, which are running through foramina intervertebralia to supply the spinal cord and rr. musculares to supply the lateral and deep muscles of the neck; A. suprascapularis runs to scapula and supplies m. supraspinatus et m. infraspinatus; the artery communicates with a. circumflexa scapulae (a. subscapularis). A. transversa colli (a. transversa cervicis) it passes through plexus brachialis, descends to angulus superior scapulae and divides into two branches: a. cervicalis superficialis and a. dorsalis scapulae. A. cervicalis superficialis (superficial branch) lies with n. accessorius and supplies m. trapezius, m. levator scapulae. A. dorsalis scapulae (deep branch) descends to margo medialis scapulae and supplies mm. rhomboidei and other muscules in this region. The subclavian artery behind m. scalenus anterior gives off truncus costocervicalis. It is about 0,5 – 1 cm long and divides into: A. cervicalis profunda runs backward between the 1st rib and the 7th cervical vertebra to supply deep muscles of the neck, deep muscles of the back; it gives rr. spinales for the cervical part of the spinal cord; A. intercostalis suprema descends in front of collum costae primae and divides into aa. intercostales posteriores, which supply the muscles of the 1st and 2nd intercostal spaces. The subclavian artery from the lateral border of m. scalenus anterior to the outer border of the first rib could give off a separate dorsal scapular artery – a. dorsalis scapulae (variation: the artery can arise from truncus thyrocervicalis); it supplies muscles around the scapula. ARTERIAE MEMBRI SUPERIORIS – ARTERIES OF THE UPPER LIMB A. AXILLARIS It is continuation of a. subclavia. It starts at the external margin of the 1st rib, passes through fossa axillaris and at the free border of m. pectoralis major continues into a. brachialis. In the axillary fossa a. axillaris is surrounded by the cords of plexus brachialis, 10 RSU Institute of Anatomy and Anthropology Vascular system, part I, arteries anteriorly to artery lies v. axillaris. The axillary artery could be divided into three parts: the first part – the part of the artery that is medial to m. pectoralis minor; the second part – the part of the artery that lies behind m. pectoralis minor; the third part – the part of the artery that is lateral to m. pectoralis minor. The axillary artery that medial to m. pectoralis minor starts below m. subclavius and supplies the deep thoracic muscles of the 1st and 2nd intercostal spaces (a. thoracica superior). The axillary artery behind m. pectoralis minor gives off: A. thoracoacromialis arises at the level of m. pectoralis minor, it is a short trunk and distributes to the branches: rr. pectorales supply m. pectoralis major et minor and glandula mammae for female, r. deltoideus supplies m. deltoideus et m. pectoralis major, r. clavicularis supplies m. subclavius, r. acromialis runs laterally and forms rete acromiale. A. thoracica lateralis – it descends along external surface of m. serratus anterior and suplies it. The artery gives rr. mammarii laterales to glandula mammae for female. The axillary artery that is lateral to m. pectoralis minor gives off: A. subscapularis – it passes along anterior surface of m. subscapularis, supplies it and divides into two arteries: a. thoracodorsalis passes downward along margo lateralis scapulae between m. serratus anterior and m. latissimus dorsi and supplies both muscles; a. circumflexa scapulae passes to fossa infraspinata, supplies m. infraspinatus and forms communication with a. suprascapularis; A. circumflexa humeri anterior runs horizontally in front of collum chirurgicum humeri, communicates with a. circumflexa humeri posterior; A. circumflexa humeri posterior leaves the axillary fossa through together with n. axillaris and curves around collum chirurgicum humeri. It communicates with a. circumflexa humeri anterior and supplies art. humeri and m. deltoideus. A. BRACHIALIS It is continuation of a. axillaris. The artery starts at the external margin of m. pectoralis major. It runs along sulcus bicipitalis medialis together with vv. brachiales, n. ulnaris, n. medianus, n. cutaneus brachii medialis, n. cutaneus antebrachii medialis. The artery lies in fossa cubitalis below aponeurosis m. bicipitis brachii and at the level of collum radii terminates by division into two terminal branches: a. radialis and a. ulnaris. A. brachialis supplies the anterior compartment of the arm and gives off: A. profunda brachii is the side branch, lies on sulcus n. radialis together with n. radialis and 2 vv. profundae brachii. The artery gives branches to posterior compartment of the arm, aa. nutritiae humeri to the bone, a. collateralis radialis and a. collateralis media for rete articulare cubiti. A. collateralis radialis runs with n. radialis between m. brachioradialis and m. brachialis and communicates with a. recurrens radialis. A. collateralis media passes backward art. cubiti and communicates with a. interossea recurrens; A. collateralis ulnaris superior accompanies n. ulnaris, lies in sulcus n. ulnaris and communicates with r. posterior from a. recurrens ulnaris; A. collateralis ulnaris inferior arises above epicondylus medialis humeri, crosses anterior surface of m. brachialis, lies between it and m. pronator teres and communicates with r. anterior from a. recurrens ulnaris. A. collateralis radialis, a. collateralis media, a. collateralis ulnaris superior et inferior form rete articulare cubiti.  RSU Institute of Anatomy and Anthropology Vascular system, part I, arteries 11 A. RADIALIS A. radialis is continuation of a. brachialis. The artery starts at the level of collum radii, travels downward between m. brachioradialis and m. flexor carpi radialis with 2 vv. radiales and r. superficialis n. radialis. The artery lies very superficially in the lower part of antebrachium and because of that above processus styloideus the pulse of it could be felt. Then the artery winds backward around processus styloideus radii, lies beneath the tendons of m. abductor pollicis longus et m. extensor pollicis brevis, passes through the anatomical snuff box and pierces muscles of the 1st intermetacarpal space. Finally a. radialis appears in the palmar side of the hand, where it communicates with r. palmaris profundus from a. ulnaris and forms arcus palmaris profundus. A. radialis supplies the anterior compartment of the forearm and the radial part of the posterior compartment. A. radialis gives off these side branches: A. recurrens radialis starts from a. radialis beginning part, communicates with a. collateralis radialis (a. profunda brachii) and forms rete art. cubiti; R. palmaris superficialis arises from a. radialis at the level of processus styloideus. It runs to the palmar surface and supplies muscles of the thumb and skin above this group, the artery communicates with the terminal part of a. ulnaris and forms arcus palmaris superficialis; R. carpalis palmaris – this small blood vessel arises near the lower border of m. pronator quadratus; R. carpalis dorsalis arises on the dorsal surface of the manus, crosses transversely the carpal bones and forms rete carpale dorsale; A. princeps pollicis arises from the terminal part of a. radialis on the palmar surface and divides into 3 aa. digitales palmares, which supply the palmar surface of the thumb and the radial side of the index finger. A. ULNARIS A. ulnaris begins at the level of collum radii and is the terminal branch of a. brachialis. The artery passes downward between m. flexor digitorum superficialis and m. flexor carpi ulnaris together with 2 vv. ulnares and n. ulnaris. It goes through canalis ulnaris; at the palm it communicates with r. palmaris superficialis from a. radialis and forms arcus palmaris superficialis. A. ulnaris supplies the ulnar side of the anterior compartment of the forearm and has side branches: A. recurrens ulnaris starts from upper part of a. ulnaris, passes to the elbow joint, divides into r. anterior et posterior and forms rete art. cubiti. R. anterior communicates with a. collateralis ulnaris inferior (a. brachialis). R. posterior communicates with a. collateralis ulnaris superior (a. brachialis); A. interossea communis starts from a. ulnaris in the upper third of the forearm, it is short artery and divides into two branches: A. interossea anterior descends along anterior surface of membrana interossea antebrachii. At the upper border of m. pronator quadratus it pierces the membrana and reaches the dorsal side of the forearm, then it passes to the wrist and finishes at rete carpale dorsale. A. interossea anterior supplies the deep layers of the anterior compartment of the forearm, gives branches to the wrist joint, the carpal joints and aa. nutritiae to the bones of the forearm. A. interossea posterior pierces membrana interossea antebrachii, descends between the muscles of the 1st and 2nd layers of the posterior compartment of the forearm and supplies it. It terminates at rete carpale dorsale. A. interossea posterior gives off a. interossea recurrens, which communicates with a. collateralis media (a. profunda brachii); R. carpalis palmaris starts above the wrist joint; R. carpalis dorsalis starts above the wrist joint and forms rete carpale dorsale; R. palmaris profundus communicates with a. radialis terminal part and forms arcus 12 RSU Institute of Anatomy and Anthropology Vascular system, part I, arteries palmaris profundus, the artery also supplies muscles of the 5th finger and skin above them. BLOOD SUPPLYING OF THE HAND Blood supplying of the palm The palm receives blood from the superficial palmar arch – arcus palmaris superficialis – and the deep palmar arch – arcus palmaris profundus. Arcus palmaris superficialis lies below aponeurosis palmaris at the middle part of the palm. It is formed by communication of the terminal part of a. ulnaris and r. palmaris superficialis of a. radialis. There are aa. digitales palmares communes, which start from the arch. Each artery at the level of art. metacarpophalangea divides into 2 to form aa. digitales palmares proprii. They supply the radial side of the little finger, the ring finger, the middle finger and the ulnar side of the index finger.The thumb and the radial side of the index finger are supplyed by aa. digitales palmares from a. princeps pollicis. Arcus palmaris profundus is placed at the bases of ossa metacarpalia. It is formed by communication of the terminal part of a. radialis and r. palmaris profundus of a. ulnaris. From the arch arise aa. metacarpales palmares, which communicate with aa. digitales palmares communes and supplement with blood the superficial arch. There are rr. perforantes, which pierce mm. interossei and communicate the arch with aa. metacarpales dorsales. The palmar side of the carpal bones, adjacent joints, bones and muscles of the wrist are supplied by r. carpalis palmaris of a. radialis, r. carpalis palmaris of a. ulnaris and a. interossea anterior (a. interossea communis). Blood supplying of the dorsal side of the hand The dorsum of the hand is supplied by rete carpale dorsale. Rete carpale dorsale lies on the dorsal side of the carpal bones and supplies the adjacent joints, bones and muscles of the wrist. It is formed by r. carpalis dorsalis of a. radialis, r. carpalis dorsalis of a. ulnaris, a. interossea anterior et posterior (a. interossea communis). There are aa. metacarpales dorsales arising from the arch. Each of them divides into 2 and forms arteries – aa. digitales dorsales. These arteries supply dorsal surfaces of fingers. The thumb and radial side of the index finger on the dorsum of the hand are supplied by the dorsal metacarpal artery arising from the radial artery. ARTERIAE TRUNCI – ARTERIES OF THE TRUNK AORTA THORACICA Aorta thoracica passes in mediastinum posterius. It begins at the lower border of the 4th thoracic vertebra and extends to the lower border of the 12th thoracic vertebra at hiatus aorticus. At the commencement aorta thoracica is situated to the left from the vertebral column, then it approaches to the median line; at its termination aorta thoracica lies directly in front of the vertebral column. At the level of the 8th – 9th thoracic vertebra aorta thoracica is crossed by the esophagus; to the left from it lies pleura costalis, to the right – v. azygos, ductus thoracicus. The side branches of aorta thoracica are divided into two groups – visceral and parietal.  RSU Institute of Anatomy and Anthropology Vascular system, part I, arteries 13 Visceral branches: Rr. bronchiales – they are the contents of radix pulmonis and supply the lungs, the bronchi and pleura visceralis; Rr. oesophageales supply the esophagus. The upper branches communicate with rr. oesophagales of a. thyroidea inferior and supply cervical part of the esophagus. The lower branches communicate with rr. oesophageales from a. gastrica sinistra and supply abdominal part of the esophagus; Rr. pericardiaci – supply the posterior surface of pericardium, communicate with branches of a. pericardiacophrenica; Rr. mediastinales are numerous vessels for supplying the lymphatic nodes, fibrous and fatty tissue in mediastinum posterius. Parietal branches: Aa. phrenicae superiores supply the diaphragm and its coverings; Aa. intercostales posteriores – there are ten paires of those arteries. They are absent in the 1st and 2nd intercostal spaces (muscles of those spaces are supplied by a. intercostalis suprema from truncus costocervicalis). The last paterior intercostal artery passes below the 12th rib and is called a. subcostalis. Each intercostal artery runs along the lower margin of the rib, lies in sulcus costae with v. intercostalis posterior above and n. intercostalis below it. Each posterior intercostal artery gives off side branches: r. dorsalis – it arises at the level of collum costae, runs backward, supplies deep muscles and skin of the back. From this branch starts r. spinalis, which passes through the intervertebral opening to supply the spinal cord and the coverings; r. collateralis – it originates near angulus costae, approaches the upper border of the rib below and supplies muscles and skin. R. collateralis and a. intercostalis posterior communicate with rr. intercostales anteriores (a. thoracica interna and a. musculophrenica); r. cutaneus lateralis – they supply skin of the lateral and anterior parts of the trunk; rr. mammarii laterales (for female) arise from the 4th – 6th posterior intercostal arteries to supply glandula mammae. Aa. intercostales posteriores supply the deep thoracic muscles, the pleura, muscles of the abdominal press of the epigastrium and mesogastrium regions, deep muscles of the back, skin of the trunk (anterior and lateral parts), the adjacent bones, the spinal cord and its coverings and glandula mammae for female. AORTA ABDOMINALIS Aorta abdominalis is continuation of aorta thoracica, it begins at hiatus aorticus front of the lower border of the 12th thoracic vertebra, descends in front of the vertebral column, ends at the level the 4th lumbar vertebra by dividing into a. iliaca communis dextra et sinistra. Sometimes between both arteries is a. sacralis mediana, which supplies m. piriformis et m. coccygeus. The abdominal aorta descends along the left side of the vertebral column. To the right of it lies v. cava inferior, anteriorly it is crossed by corpus pancreatis, pars ascendens duodeni and radix mesenterii. The abdominal aorta has two groups of the side branches – visceral and parietal. Visceral branches could be divided into two groups – the unpaired and paired branches. The unpaired visceral branches of the abdominal aorta: truncus coeliacus, a. mesenterica superior, a. mesenterica inferior. 14 RSU Institute of Anatomy and Anthropology Vascular system, part I, arteries TRUNCUS COELIACUS Truncus coeliacus arises from the abdominal aorta just bellow hiatus aorticus at the level of the 12th thoracic vertebra, is about 1 – 3 cm long and divides into 3 arteries: a. gastrica sinistra, a. splenica and a. hepatica communis. A. gastrica sinistra passes upward and backward, approaches the abdominal part of the oesophagus, descends to the cardiac orifice and then along curvatura minor and supplies the stomach. It gives branches: rr. oesophageales for abdominal part of the oesophagus). The artery communicates with a. gastrica dextra (a. hepatica communis). A. splenica runs horizontally to the left behind the stomach along the upper margin of the pancreas. It terminates at hilum lienis by division into rr. splenici and supply the spleen. A. splenica side branches: rr. pancreatici supply corpus et cauda pancreatis, aa. gastricae breves supply fundus gastrici, a. gastroomentalis sinistra descends along curvatura major, communicates with a. gastroomentalis dextra (a. gastroduodenalis) and supplies the stomach and omentum majus. A. hepatica communis runs to the right and downward to the upper margin of pars superior duodeni and gives off one side branch – a. gastrica dextra. A. gastrica dextra passes along curvatura minor, communicates with a. gastrica sinistra (truncus coeliacus) and supplies the stomach. A. hepatica communis divides into two terminal arteries: a. hepatica propria and a. gastroduodenalis. A. hepatica propria passes together with ductus choledochus and v. portae between the layers of lig. hepatoduodenale. At porta hepatis it divides into r. dexter et r. sinister to supply the corresponding lobes of the liver. A. cystica arises from r. dexter and supplies the gall bladder. A. gastroduodenalis descends behind duodenum and divides into two branches: a. gastroomentalis dextra and aa. pancreaticoduodenales superiores. A. gastroomentalis dextra ascends along curvatura major, communicates with a. gastroomentalis sinistra (a. splenica). Aa. pancreaticoduodenales superiores lies between duodenum and caput pancreatis, supply both and communicates with a. pancreaticoduodenalis inferior (a. mesenterica superior). A. MESENTERICA SUPERIOR A. mesenterica superior arises at the level of the 1 st lumbar vertebra and lies between caput pancreatis and pars inferior duodeni; then it descends between the layers of radix mesenterii to the right ileocaecal region and terminates as a. ileocolica to supply the caecum and terminal part of the ileum. A. ileocolica gives small branch a. appendicularis to appendix vermiformis. Side branches of a. mesenterica superior: Aa. jejunales et aa. ileales (12 – 18) arise on the left side of the superior mesenteric artery and supply jejunum et ileum. They run parallel to each other between the layers of the mesentery. There are numerous anastomotic arches between the arteries; A. pancreaticoduodenalis inferior is the first to arise from the right side of superior mesenteric artery; it goes retroperitoneally, supplies caput pancreatis and duodenum, communicates with aa. pancreaticoduodenales superiores (a. gastroduodenalis); A. colica dextra lies behind the peritoneum, passes to the middle part of colon ascendens and supplies it. The artery divides into two branches: r. descendens (descends along colon ascendens and communicates with a. ileocolica), r. ascendens (communicates with a. colica media); A. colica media goes between the layers of mesocolon transversum and supplies colon transversum till the left third. It divides into two branches: r. dexter (communicates with r. ascendens of a. colica dextra) and r. sinister (communicates with r. ascendens of a. colica sinistra, a. mesenterica inferior). Communication between branches of a. mesenterica superior et inferior is called arcus  RSU Institute of Anatomy and Anthropology Vascular system, part I, arteries 15 marginalis coli. It is formed by r. sinister of a. colica media (a. mesenterica superior) and r. ascendens of a. colica sinistra (a. mesenterica inferior). A. MESENTERICA INFERIOR A. mesenterica inferior arises from aorta abdominalis at the level of the 3rd lumbar vertebra, descends behind the peritoneum, continues into the pelvic cavity and terminates as a. rectalis superior, which supplies the upper third of the rectum. A. mesenterica inferior gives side branches: A. colica sinistra runs behind the peritoneum to supply colon descendens and the left third of colon transversum, the artery gives r. ascendens (communicates with r. sinister of a. colica media), and r. descendens (communicates with aa. sigmoideae); Aa. sigmoideae – they run between layers of mesocolon sigmoideum and supply colon sigmoideum. Into upper direction aa. sigmoideae communicate with r. descendens (a. colica sinistra), into lower – with a. rectalis superior. The paired visceral branches of the abdominal aorta: a. suprarenalis media, a. renalis, a. testicularis (for male) or a. ovarica (for female). A. suprarenalis media arises from the abdominal aorta at the level of the 1st lumbar vertebra at the right angle and supplies glandula suprarenalis. A. renalis arises from the abdominal aorta at the level of the 2nd lumbar vertebra at the right angle. It supplies kidney and gives side branches: a. suprarenalis inferior – supplies glandula suprarenalis, rr. ureterici – supply the upper third of the ureter. A. testicularis (for male) arises from the abdominal aorta at the level of the 2nd or 3rd lumbar vertebra and runs behind the peritoneum. It crosses the ureter and reaches anulus profundus of the inguinal canal. Then it passes through the canal, is one of the components of funiculus spermaticus and supplies testis et epidydimis. A. testicularis gives rr. ureterici to the middle third of the ureter. A. ovarica (for female) arises from aorta at the level of the 2nd or 3rd lumbar vertebra and runs behind peritoneum. It crosses the ureter, then linea terminalis. In the lesser pelvis it runs as a content of lig. suspensorium ovarii, reaches hilum ovarii, where it anastomoses with r. ovaricus (a. uterina) and supplies the ovary. A. ovarica gives off rr. ureterici to the middle third of the ureter and rr. tubarii to supply tuba uterina. The parietal branches of the abdominal aorta: Aa. phrenicae inferiores arise from the aorta at the level of the 12th thoracic vertebra. They supply the lower surface of the diaphragm and give off a. suprarenalis superior to glandula suprarenalis. Aa. lumbales are usually four and they supply the posterior and lateral abdominal muscles. Each artery gives r. dorsalis – it upplies deep muscles and skin of the back and r. spinalis, which runs through the intervertebral opening to supply the spinal cord and coverings of it. The terminal branches of the abdominal aorta: A. ILIACA COMMUNIS A. iliaca communis is the terminal branch of aorta abdominalis; it is about 5 cm long, starts at the level of the 4th lumbar vertebra, runs downward and laterally. At the level of art. sacroiliaca it divides into two arteries: a. iliaca externa and a. iliaca interna. 16 RSU Institute of Anatomy and Anthropology Vascular system, part I, arteries A. ILIACA EXTERNA A. iliaca externa runs along linea terminalis forward, passes through lacuna vasorum and continues to the lower extremity as a. femoralis. The artery along its course gives off side branches: A. circumflexa ilium profunda passes along lig. inguinale et crista iliaca and communicates with r. iliacus from a. iliolumbalis. It supplies the abdominal muscles and anterior muscles of the pelvic girdle; A. epigastrica inferior ascends obliquely between layers of vagina m. recti abdominis and supplies muscles of the anterior wall of the abdominal cavity. The peritoneum forms fold above the artery – plica umbilicalis lateralis. A. epigastrica inferior communicates with a. epigastrica superior (a. thoracica interna) at the umbilicus region. The artery gives off side branches: r. pubicus goes along internal surface of ramus superior ossis pubis and anastomoses with r. pubicus from a. obturatoria. This communication lies near internal opening of canalis femoralis and is called corona mortis; it could be injured in surgery, a. cremasterica (for male) enters canalis inguinalis, supplies m. cremaster and coverings of funiculus spermaticus, a. ligamenti teretis uteri (for female) enters canalis inguinalis, supplies lig. teres uteri. A. ILIACA INTERNA A. iliaca interna runs along the lateral wall of the lesser pelvis and has two groups of branches – visceral and parietal. Parietal branches of a. iliaca interna: A. iliolumbalis ascends, crosses linea terminalis, enters pelvis major and divides into two branches: r. lumbalis supplies muscles of the posterior wall of the abdominal cavity; r. iliacus passes along crista iliaca and supplies muscles of the anterior wall of the abdominal cavity. R. iliacus anastomoses with a. circumflexa ilium profunda (a. iliaca externa); Aa. sacrales laterales (usually there are two – superior et inferior) – they descend along facies pelvina ossis sacri together with a. sacralis mediana and supply muscles of the pelvic girdle and perineum. They give off rr. spinales, which through foramina sacralia anteriora enter the sacral canal and supply cauda equina; A. obturatoria runs forward and downward along the lateral wall of pelvis minor, then goes through canalis obturatorius and on the thigh divides into two branches – r. anterior et r. posterior. The terminal branches supply muscles of the medial compartment of the thigh and m. obturator externus. The artery on its pathway gives off two side branches: r. pubicus – it supplies the pubic region and anastomoses with r. pubicus of a. epigastrica inferior, r. acetabularis – it runs as a content of lig. capitis femoris into art. coxae and supplies caput femoris; A. glutea superior leaves the pelvic cavity through the space above m. piriformis and supplies m. gluteus minimus, m. gluteus medius, m. tensor fascia latae and art. coxae; A. glutea inferior emerges through the space below m. piriformis and supplies m. gluteus maximus, m. piriformis, m. obturator internus, mm. gemelli, m. quadratus femoris and also m. levator ani. Visceral branches: A. umbilicalis – it ascends along the urinary bladder and anterior wall of the abdominal cavity to the umbilicus. The peritoneum forms plica umbilicalis medialis above this artery. After birth the most part of the artery obliterates and transformes into a solid  RSU Institute of Anatomy and Anthropology Vascular system, part I, arteries 17 fibrous cord – lig. umbilicale mediale. The lumen of the artery retains only for a small distance in the pelvic portion. From this part arise side branches – aa. vesicales superiores for supplying apex et corpus vesicae; a. ductus deferentis (for male) accompanies ductus deferens, supplies it and vesicula seminalis; the artery gives branches rr. ureterici to supply the lower third of the ureter; Aa. vesicales inferiores supply fundus vesicae, prostata for male and anterior wall of the vagina for female; A. uterina (for female) runs along the lateral wall of the pelvic cavity, then turns medially and passes along lig. cardinale uteri to cervix uteri. Then it ascends along the lateral side of the uterus to angulus uteri, where it divides into two branches: r. tubarius supplies tuba uterina and mesosalpinx; r. ovaricus directs along lig. ovarii proprium to the ovary and anastomoses with a. ovarica (aorta abdominalis). A. uterina supplies anterior and posterior walls of the uterus and gives side branches: rr. ureterici – for the lower third of the ureter and a. vaginalis – for the vagina; A. rectalis media – it supplies the middle third of the rectum, anastomoses with a. rectalis superior (a. mesenterica inferior) and with a. rectalis inferior (a. pudenda interna); for male the artery gives rr. prostatici to the prostata; A. pudenda interna – the artery leaves the pelvic cavity through the space below m. piriformis, winds around spina ischiadica and through foramen ischiadicum minus enters fossa ischioanalis. It terminates to supply the external genitals and terminates by division into branches: for male – a. dorsalis penis et a. profunda penis, for female – a. dorsalis clitoridis et a. profunda clitoridis. The side branches of a. pudenda interna: a. rectalis inferior supplies the lower third of the rectum, a. perinealis supplies muscles of the perineum and gives branches to the external genitals: for male – rr. scrotales posteriores to supply the posterior surface of the scrotum, for female – rr. labiales posteriores to supply posterior parts of labia pudendi majora, a. urethralis supplies the urethra, a. bulbi penis (for male) – supplies bulbus penis, bulbi vestibuli (for female) – supplies bulbus vestibuli. ARTERIAE MEMBRI INFERIORIS LIBERI – ARTERIES OF THE LOWER LIMB A. FEMORALIS A. femoralis is a continuation of a. iliaca externa below lig. inguinale. In trigonum femorale it lies between m. iliopsoas and m. pectineus, then the artery descends and goes through canalis adductorius. It leaves the canal at the lower orifice and continues as a. poplitea. A. femoralis gives off two groups of side branches – superficial and deep. The superficial side branches of the femoral artery: A. circumflexa ilium superficialis goes laterally along lig. inguinale to spina iliaca anterior superior, supplies skin, subcutaneous tissue and the fascia; A. epigastrica superficialis starts at the level of hiatus saphenus fasciae latae, ascends in front of lig. inguinale between the subcutaneous tissue and finishes in the region of the umbilicus. It supplies the lower part of aponeurosis m. obliqui abdominis externi, skin, subcutaneous tissue and fascia of the anterior wall of the abdominal cavity below the umbilicus; Aa. pudendae externae supply the external genitals and rr. inguinales supply the inguinal lymphatic nodes; for male they terminate as rr. scrotales anteriores, for female – rr. labiales anteriores; 18 RSU Institute of Anatomy and Anthropology Vascular system, part I, arteries The deep side branches of the femoral artery: A. profunda femoris arises from a. femoralis about 3 – 4 cm below lig. inguinale, descends behind a. femoralis and supplies muscles of the thigh. The artery along its course gives off side branches: a. circumflexa femoris lateralis – it supplies muscles of the anterior compartment of the thigh and art. coxae, a. circumflexa femoris medialis – it supplies muscles of the medial compartment of the thigh and art. coxae, aa. perforantes – there are the 1st, the 2nd and the 3rd perforating arteries, which pierce muscles of the medial compartment and run to supply muscles of the posterior group of the thigh; A. descendens genus – it arises from a. femoralis in canalis adductorius, pierces the anterior wall of the canal and descends together with n. saphenus; the artery takes part in formation of rete articulare genu for supplying the knee joint. A. POPLITEA It is a direct continuation of a. femoralis. It starts at the lower opening of canalis adductorius, runs through fossa poplitea and lies very closely to the bones and articular capsula. At the lower part of fossa poplitea it divides into two terminal branches: a. tibialis anterior and a. tibialis posterior. A. poplitea gives off 6 side branches for rete articulare genu and superficial muscles of the posterior group of the lower leg. The side branches of a. poplitea: A. superior medialis genus winds around condylus medialis femoris to form rete articulare genu; A. superior lateralis genus winds around condylus lateralis femoris to form rete articulare genu; A. media genus – it pierces the articular capsula, enters the articular cavity and supplies ligaments, meniscs, synovial folds; A. inferior medialis genus winds around condylus medialis tibiae to form rete articulare genu; A. inferior lateralis genus winds around caput fibulae to form rete articulare genu; Aa. surales – they descends and supply m. triceps surae. A. TIBIALIS ANTERIOR A. tibialis anterior is one of the terminal branches of a. poplitea. The artery pass through the orifice in membrana interossea cruris and descends along the membrana between the muscles of the anterior compartment together with n. fibularis profundus (n. peroneus profundus) and 2 vv. tibiales anteriores and supplies muscles of the anterior compartment of the leg. A. tibialis anterior runs below retinaculum musculorum extensorum superius et inferius and continues on the dorsal surface of the foot as a. dorsalis pedis. The side branches of a. tibialis anterior: A. recurrens tibialis posterior – it is variable artery. It ascends and participates in formation of rete articulare genu; A. recurrens tibialis anterior arises from the artery as soon as that vessel runs along the membrana between the muscles of the anterior compartment of the leg; the artery ascends and forms rete articulare genu; A. malleolaris anterior medialis – it winds around malleolus medialis and forms rete malleolare mediale; A. malleolaris anterior lateralis – it winds around malleolus lateralis and forms rete malleolare laterale.  RSU Institute of Anatomy and Anthropology Vascular system, part I, arteries 19 A. dorsalis pedis It is the terminal branch of a. tibialis anterior. It starts at the level of retinaculum musculorum extensorum inferius and passes between the tendons of m. extensor hallucis longus et brevis. Laterally to the tendon of m. extensor hallucis longus the pulse can be palpated. Artery divides into two terminal branches at the 1st intermetatarsal space: A. metatarsalis dorsalis prima runs forward and divides into 3 arteries – aa. digitales dorsales, which supply the dorsal surface of the 1st and half of the 2nd toes; A. plantaris profunda – it pierces muscles of the 1st intermetatarsal space to the sole and participates in formation of arcus plantaris pedis. The side branches of a. dorsalis pedis: Aa. tarsales mediales – they supply the medial side of the foot and muscles of the 1st toe on the plantar surface; A. tarsalis lateralis – it starts at the level of caput tali, crosses the dorsal surface, goes laterally and anastomoses with a. arcuata; A. arcuata – it passes laterally over the bases of the metatarsal bones and anastomoses with a. tarsea lateralis. There are aa. metatarsals dorsales arising from a. arcuata and dividing into aa. digitales dorsales. They supply lateral side of the 2nd toe, the 3rd, the 4th toes and the medial side of the 5th toe. From aa. metatarsales dorsales start rr. perforantes. A. TIBIALIS POSTERIOR A. tibialis posterior is one of the terminal branches of a. poplitea. It descends between deep flexors and m. soleus and is accompanied by 2 vv. tibiales posteriores and n. tibialis, curves malleolus medialis posteriorly, goes below retinaculum musculorum flexorum to the plantar surface, where it divides into two terminal branches: a. plantaris medialis et lateralis. A. tibialis posterior supplies muscles of the posterior compartment of the leg and gives the side branches: R. circumflexus fibularis ascends to the knee joint, turns around caput fibulae and participates in formation of rete articulare genu; A. nutritia tibiae – it supplies tibia; Rr. malleolares mediales form rete malleolare mediale; Rr. calcanei form rete calcaneum; A. fibularis (a. peronea) starts from the artery at the upper third, descends and terminates by rr. calcanei to form rete calcaneum. A. peronea supplies muscles of the lateral compartment of the leg and gives side branches: a. nutritia fibulae (supplies fibula) and rr. malleolares laterales (form rete malleolare laterale). A. plantaris lateralis It runs forward together with 2 vv. plantares laterales and n. plantaris lateralis. At the base of the 5th metatarsal bone it turns medially and joins with a. plantaris profunda (a. dorsalis pedis) and forms arcus plantaris profundus for supplying the plantar side of the foot. From arcus plantaris profundus start aa. metatarsales plantares and they divide into aa. digitales plantares communes and aa. digitales plantares proprii. A. plantaris medialis It runs together with 2 vv. plantares mediales and n. plantaris medialis. The artery anastomoses with a. metatarsalis dorsalis prima and supplies muscles of the 1st toe. 20 RSU Institute of Anatomy and Anthropology Vascular system, part I, arteries BLOOD SUPPLYING OF THE JOINTS OF THE LOWER LIMB Rete articulare genu; Rete malleolare mediale – supplies malleolus medialis, art. talocruralis and ossa tarsalia; Rete malleolare laterale – supplies malleolus lateralis, art. talocruralis and ossa tarsalia; Rete calcaneum.  RSU Institute of Anatomy and Anthropology Vascular system, part II, veins 1 VENOUS SYSTEMS The blood flow in veins is from the periphery to the center. Veins of the systemic circulation could be divided into four systems due their fusion: 1) veins of the heart, which terminate directly into the right atrium; 2) cava superior system joins the veins of the head, neck, upper limb and thorax, which terminate into superior vena cava – vena cava superior; 3) cava inferior system joins the veins of the lower limb, abdomen and pelvis, which terminate into inferior vena cava – vena cava inferior; 4) portal system contains the hepatic portal vein – vena portae hepatis. VEINS OF THE HEART The veins of the heart (vv. cordis) drain blood directly into the hearts cavities. To them belong: 1) sinus coronarius, 2) vv. cordis anteriores, 3) vv. cordis minimae. Sinus coronarius By sinus coronarius is drained the main part of the venous blood. It lies in posterior part of the heart in sulcus coronarius and terminates in the right atrium by ostium sinus coronarii. The sinus receives 5 tributaries: V. cardiaca magna – it begins at apex cordis, ascends along sulcus interventricularis anterior, curves to the left around facies pulmonalis cordis, lies in sulcus coronarius and ends in the sinus; V. cardiaca media commences at apex cordis, ascends along sulcus interventricularis posterior, opens into the sinus; V. cardiaca parva runs along sulcus coronarius between the right atrium and right ventricle, curves around margo dexter cordis and opens into the sinus; V. ventriculi sinistri posterior drains the venous blood from the left ventricle and ends in the sinus; V. obliqua atrii sinistri drains the venous blood from the left atrium, opens into the sinus. Vv. cordis anteriores are located on facies sternocostalis. They drain the right ventricle and open directly into the right atrium by means of small orifices. Vv. cordis minimae are numerous, they arise in the wall of the heart and open mainly into the right atrium by foramina venarum minimarum, but could open also into the ventricle. 2 RSU Institute of Anatomy and Anthropology Vascular system, part II, veins VEINS OF THE HEAD The veins of the head could be divided into several groups: external veins of the head and face, dural venous sinuses – sinus durae matris, diploic veins – venae diploicae, emissary veins – venae emissariae, cerebral veins and orbital veins. External veins of the head and face are present outside of the cranial cavity in the soft tissue. They drain skin, muscles and some internal organs of the head. The main veins are: v. facialis, v. lingualis, v. temporalis superficialis, v. retromandibularis, v. auricularis posterior, v. occipitalis, plexus pterygoideus. V. facialis commences at the root of the nose as v. angularis and anastomoses with v. nasofrontalis (v. ophthalmica superior). This communication is important in the spread of bacterial infections from the face to the cranial cavity. V. facialis runs obliquely downward and backward; in trigonum caroticum it unites with anterior root of v. retromandibularis and opens into v. jugularis interna. V. facialis drains the anterior part of the face: the eyelids, the lips, regio submentalis, m. masseter, the superficial part of the parotid gland, plexus pterygoideus, tonsilla palatina, palatum molle, lateral part of the pharynx. The biggest tributary of v. facialis is v. facialis profunda, which drains plexus pterygoideus. V. lingualis is formed by v. profunda linguae (drains the inferior surface of the tongue), v. dorsalis linguae (drains dorsum linguae), v. sublingualis (drains glandula sublingualis). V. lingualis enters v. jugularis interna. V. temporalis superficialis begins by the venous plexus in the temporal and calvaria regions. The vein drains the parietal, temporal and frontal regions. It crosses arcus zygomaticus, enters the substance of the parotid gland, joins with v. maxillaris at the level of collum mandibulae and forms v. retromandibularis, which is placed in fossa retromandibularis. V. retromandibularis passes through glandula parotidea and divides into 2 roots: anterior root joins with v. facialis, but posterior – communicates with v. auricularis posterior to form v. jugularis externa. Plexus pterygoideus lies in fossa infratemporalis between m. pterygoideus medialis et lateralis. The plexus provides the venous drainage of the mastication muscles, the teeth, art. temporomandibularis, deep part of the parotid gland, the nasal cavity, sinus maxillaris, auris externa et media. It also receives v. meningea media – which drains the meninges and pass through foramen spinosum. Plexus pterygoideus is drained into 2 directions: a) forward into v. facialis via v. facialis profunda, b) backward – into v. retromandibularis via v. maxillaris. Plexus pterygoideus communicates with the intracranial venous sinuses through foramen ovale, canalis caroticus. V. auricularis posterior originates by the venosus plexus behind the ear, passes downward together with a. auricularis posterior, joins v. occipitalis to form a short trunk, which is the posterior root of v. jugularis externa. V. auricularis posterior drains auricula and the lateral part of the occipital region. V. occipitalis begins from the superficial and deep venous plexus of the occipital region. V. occipitalis follows the course of a. occipitalis and terminates by communication with v. auricularis posterior. It drains the occipital region. Dural venous sinuses are venous channels draining blood from the brain and cranial bones. They do not have valves and between two layers of dura mater: Sinus sagittalis superior lies on convex margin of falx cerebri. It begins near crista galli and receives there a vein from the nasal cavity through foramen caecum. Near  RSU Institute of Anatomy and Anthropology Vascular system, part II, veins 3 protuberantia occipitalis interna it deviates, usually to the right, continuing as sinus transversus. It is 1 cm wide, triangular in cross section and enlarges backwards. Sometimes it has septs. On both sides of it usually there are three irregular venous lacunae, communicated with the sinus by small orifices. In elderly the lacunae tend to become confluent as one elongated lacuna on each side. Tributaries of sinus sagittalis superior are vv. superiores cerebri, vv. diploicae, vv. meningeae, v. emissaria parietalis. Connection between sinus sagittalis superior and veins of the nose explane occasional spread of infections. Posterior end of sinus sagittalis superior is dilated – confluens sinuum. It is situated on the right side of protuberantia occipitalis interna and connects with sinus occipitalis and sinus transverses. Sinus sagittalis inferior lies on posterior half of the free margin of falx cerebri and increases in size posteriorly; the sinus ends in sinus rectus. Sinus rectus lies between falx cerebri and tentorium cerebelli. It is triangular in cross section; runs backward and continues into sinus transversus. Tributary: v. cerebri magna. Sinus transversus begins at protuberantia occipitalis interna. On the right side it directly continuous into sinus sagittalis superior, on the left side into sinus rectus. It runs laterally and downward, lies on attached margin of tentorium cerebelli, is triangular in shape in cross section. Tributaries: vv. inferiores cerebri, vv. cerebelli, vv. diploicae. Sinus sigmoideus is continuation of sinus transversus, it runs forward to the superior jugular bulb to continue into v. jugularis interna. Sinus occipitalis – the smallest of the sinuses, lies on attached margin of falx cerebelli, communicates with confluens sinuum and sinus sigmoideus. Sinus cavernosus – it extends from fissura orbitalis superior to apex partis petrosae; it is 2 cm long, 1 cm wide and by septs is divided into cavernae. Through it passes a. carotis interna and n. abducens inferiorly and laterally to the artery. In the lateral wall of the sinus lies n. oculomotorius, n. trochlearis, n. ophthalmicus, n. maxillaris. Sinus has important relations: medially to it lies hypophysis cerebri, inferiorly – sinus sphenoidalis, superiorly – chiasma opticum, laterally – fossa cranii media. Tributaries: vv. ophthalmicae, v. centralis retinae, v. media superficialis cerebri, v. meningea media, vv. inferiores cerebri, sinus sphenoparietalis. Sinus intercavernosus anterior, Sinus intercavernosus posterior – the last two sinuses communicate with sinus cavernosus of the both sides and all together form the venous circular sinus; Sinus sphenoparietalis runs along free margin of ala minor ossis sphenoidalis and has small tributaries from the adjacent lobes; Sinus petrosus superior is small and narrow; lies in attached margin of tentorium cerebelli, drains sinus cavernosus to sinus transversus. Tributaries: vv. cerebelli, vv. inferiores cerebri. Sinus petrosus inferior – drains sinus cavernosus to v. jugularis interna. Tributaries: vv. cerebelli, vv. labyrinthi (from the internal ear), v. aqueductus vestibuli (from the internal ear). Plexus basilaris – consists of interconnecting channels, lies between layers of dura mater on the clivus. It communicates sinus petrosus superior, sinus petrosus inferior and sinus cavernosus of both sides. It communicates also with plexus vertebralis internus through the foramen magnum and so it is an anastomosis with external veins. Diploic veins – vv. diploicae lie in diploe and drain it. The terminal parts of those veins enter the venous sinuses, but beginning parts run through the bones of the skull and communicate with external veins of the head; Emissary veins – vv. emissariae are short trunks connecting sinus durae matris inside 4 RSU Institute of Anatomy and Anthropology Vascular system, part II, veins the skull and the veins external to it; they are anastomoses between dural venous sinuses and external veins: v. emissaria parietalis runs through foramen parietale connecting sinus sagittalis superior with v. temporalis superficialis, v. emissaria mastoidea runs through foramen mastoideum connecting sinus sigmoideus with v. occipitalis, v. emissaria occipitalis runs through foramen occipitale connecting sinus transversus or confluens sinuum with v. occipitalis, v. emissaria condylaris runs through canalis condylaris connecting sinus sigmoideus with plexus venosus vertebralis externus; Like emissary veins there are also venous networks in the openings at the base of the skull: plexus venosus foraminis ovalis – in foramen ovale, the plexus connects sinus cavernosus with plexus pterygoideus; plexus venosus caroticus internus – in canalis caroticus, the plexus connects sinus cavernosus with plexus pterygoideus; plexus venosus canalis nervi hypoglossi – in canalis hypoglossus, this plexus connects sinus occipitalis with plexus venosus vertebralis externus. Cerebral veins – vv. encephali form groups: Vv. superficiales cerebri collect the blood from cortex cerebri: vv. superiores cerebri (8 – 12) drain facies superolateralis et medialis hemispherii cerebri and open into sinus sagittalis superior, v. media superficialis cerebri drains lobus frontalis, lobus parietalis, lobus temporalis and flows into sinus cavernosus, vv. inferiores cerebri drain inferior surface of the brain and flow into adjacent venous sinuses; vv. superiores et inferiores cerebelli drain the cerebellum and flow into sinus petrosus superior et inferior, sinus sigmoideus, sinus transversus. Vv. profundae cerebri drain substantia alba hemispherii, nuclei basales, plexus chorioidei. There are 4 paired veins and 1 unpaired vein: v. thalamostriata superior drains thalamus, nucleus caudatus, capsula interna, v. choroidea superior drains plexus chorioideus ventriculi lateralis, v. anterior septi pellucidi drains cornu anterius ventriculi lateralis, v. interna cerebri is formed near foramen interventriculare by joining three veins – v. thalamostriata superior, v. choroidea superior and v. anterior septi pellucidi; v. interna cerebri lies between two laminas of tela choroidea ventriculi tertii; at the the posterior wall of the 3rd ventricle the veins of both sides join to form one single vein – v. magna cerebri, v. magna cerebri is about 1 cm long unpaired vein; it opens into sinus rectus and has tributary – v. basalis, which drains hypothalamus and nuclei basales. Veins of the brainstem – they drain blood to v. magna cerebri, vv. cerebelli, sinus petrosus inferior, sinus rectus. Orbital veins – vv. orbitae drain the optic cavity. They form anastomoses between dural venous sinuses and external veins of the head. There are two ophthalmic veins: V. ophthalmica superior begins at the medial corner of the eye as v. nasofrontalis and receives tributaries from the eye and its additional structures. It runs along the upper wall of the optic cavity, then through fissura orbitalis superior and enters sinus cavernosus, V. ophthalmica inferior could start by the lacrimal veins or by anastomoses with v. ophthalmica superior. It runs backward along the inferior wall of the optic cavity, then  RSU Institute of Anatomy and Anthropology Vascular system, part II, veins 5 divides into 2 branches: one branch joins plexus pterygoideus through fissura orbitalis inferior, the other one enters the cranial cavity through fissura orbitalis superior and terminates into sinus cavernosus. Anastomoses between veins Some veins are anastomoses between the venous sinuses and external veins of the head: 1) vv. diploicae; 2) v. meningea media; 3) vv. ophthalmicae; 4) vv. emissariae; 5) plexus s. sinus basilaris lies on the clivus. Laterally it communicates with sinus petrosus inferior; downward through foramen magnum it goes to spatium epidurale and communicates with plexus venosus vertebralis internus. VEINS OF THE NECK The veins of the neck are v. jugularis externa and v. jugularis interna. V. JUGULARIS EXTERNA V. jugularis externa is formed by two roots: posterior root is formed by union of v. occipitalis and v. auricularis posterior, anterior – by v. retromandibularis. Both roots join at the level of angulus mandibulae. The commencement of v. jugularis externa is placed in the substance of glandula parotidea. It runs downward and posteriorly beneath platysma, along m. sternocleidomastoideus, it pierces lamina superficialis fasciae colli and finishes in angulus venosus juguli. The main tributaries of v. jugularis externa: Vv. transversae colli goes with a. transversa colli, drains superficial muscles of the back and deep muscles in the neck region; V. suprascapularis drains muscles of the scapular region; V. jugularis anterior drains the anterior superficial layers of the neck. V. jugularis externa also collects the blood from the occipital region and lateral parts of the face. V. jugularis anterior begins at the level of os hyoideum. It descends 1 – 2 cm laterally from the middle line in front of straight muscles of the neck. Above incisura jugularis sterni veins of both sides communicate by arcus venosus juguli. Then the vein curves laterally and opens into v. jugularis externa. In some cases there is only one vein in the anterior region – v. mediana colli, which joins v. jugularis externa on one side. V. JUGULARIS INTERNA V. jugularis interna provides the venous drainage of the head and neck. V. jugularis interna begins at foramen jugulare, communicates with sinus sigmoideus and at the base of the skull has enlargement bulbus superior venae jugularis. The internal jugular vein runs downward and in upper part lies behind a. carotis interna, then as a content of the carotid sheath – laterally to a. carotis communis. A little above the veins termination is a second enlargement – bulbus inferior venae jugularis. The union of v. jugularis interna and v. subclavia forms v. brachiocephalica. This connection place is called angulus venosus juguli. In angulus venosus juguli opens v. jugularis externa – on both sides, ductus lymphaticus dexter – on the right side, ductus thoracicus – on the left side. 6 RSU Institute of Anatomy and Anthropology Vascular system, part II, veins V. jugularis interna tributaries are: 1) sinus durae matris; 2) v. facialis; 3) v. lingualis; 4) vv. pharyngeae – they drain plexus pharyngeus, tuba auditiva, palatum molle; 5) v. thyroidea superior drains plexus thyroideus and receives tributary v. laryngea superior; 6) v. sternocleidomastoidea. VEINS OF THE TRUNK V. BRACHIOCEPHALICA V. brachiocephalica drains the head, neck and upper limb; it is formed by union of v. jugularis interna and v. subclavia behind the sternoclavicular joint. V. brachiocephalica dextra is about 3 cm long. It commences at the level of art. sternoclavicularis dx., descends straight downward to the 1st rib and joins the left brachiocephalic vein. V. brachiocephalica sinistra is twice longer (about 6 cm long) with oblique course behind manubrium sterni. It crosses n. phrenicus sin, n. vagus sin, a. subclavia sin, a. carotis communis sin, trachea, truncus brachiocephalicus. V. brachiocephalica tributaries: V. thyroidea inferior drains plexus thyreoideus impar, which lies in the lower part of the thyroid gland and anastomoses with plexus thyroideus; plexus thyroideus impar drains the adjacent organs – the larynx, the upper parts of the trachea and oesophagus, the thymus; V. vertebralis starts from plexus venosus vertebralis externus at the level of arcus posterior atlantis, follows the course of a. vertebralis through foramina transversaria of the cervical vertebra. It drains plexus venosus vertebralis externus et internus and the deep muscles of the back in the neck region. Plexus venosus vertebralis externus – is the best marked in the cervical region, consists of anterior plexus (lies in front of the bodies of vertebrae) and posterior plexus (placed on the posterior surfaces of the vertebral arches); they anastomose freely with each another. The external vertebral venous plexus has anastomoses with vertebral, occipital and deep cervical veins, v. emissaria condylaris and the plexus venosus canalis nervi hypoglossi. The internal vertebral venous plexus – plexus venosus vertebralis internus – is located within the vertebral canal (in the epidural space – spatium epidurale) between the spinal dura mater and the vertebrae. It receives tributaries from the bones and from the spinal cord. Around the foramen magnum it forms a network which opens into the vertebral veins. It is connected above with the occipital sinus. V. cervicalis profunda starts from plexus venosus vertebralis externus and drains the occipital region; Vv. thoracicae internae accompanies the artery with the same name and drains the same parts of the body as artery supplies; V. intercostalis suprema dextra et sinistra drains the upper 1 – 2 intercostal spaces; V. intercostalis superior sinistra drains the upper 3 – 4 intercostal spaces of left side. V. CAVA SUPERIOR V. cava superior drains the upper part of the trunk above the diaphragm. It is about 7 cm long, 2 cm in diameter. V. cava superior is formed by union of v. brachiocephalica dextra et sinistra behind synchondrosis costae primae dx, it lies in mediastinum superius, runs from the cartilage of the 1st right rib to the cartilage of the 3rd right rib. Lower part of v. cava superior is within the pericardium. Left to it lies aorta; to the right – pars mediastinalis pleurae parietalis, n. phrenicus, vasa pericardiacophrenica; behind it – bronchus principalis dx, a. pulmonalis dx, vv. pulmonales dx; anteriorly – thymus.  RSU Institute of Anatomy and Anthropology Vascular system, part II, veins 7 It has only one tributary – vena azygos. V. AZYGOS V. azygos is upward continuation of v. lumbalis ascendens dx. from the abdominal cavity, it passes through muscles of the diaphragm. It ascends in mediastinum posterius to the right of the vertebral column. Then at the level of the 4th thoracic vertebra v. azygos arches forward above the root of the right lung to end in v. cava superior from behind. V. azygos has visceral and parietal tributaries. Visceral tributaries of v. azygos: Vv. oesophageales drain plexus venosus oesophageus; Vv. bronchiales drain the bronchi, lungs and pleura; Vv. pericardiacae drain the posterior side of pericardium; Vv. mediastinales drain the lymphatic nodes of mediastinum. Parietal tributaries of v. azygos: Vv. phrenicae superiores drain the diaphragm; Vv. intercostales posteriores dextrae drain 8 lower intercostal spaces on the right side; V. intercostalis superior dextra drains 3 – 4 upper intercostal spaces on the right side, it is also an anastomotic tributary to v. brachiocephalica dextra; V. hemiazygos – it starts like v. azygos, but on the left side as v. lumbalis ascendens sin. At the level of the 8th – 9th thoracic vertebra it crosses the vertebral column to join v. azygos. V. hemiazygos lies posteriorly to aorta, oesophagus and ductus thoracicus. V. hemiazygos has its own tributaries: vv. intercostales posteriores sinistrae (drain 4 – 5 lower intercostal spaces) and v. hemiazygos accessoria – it is formed by union of 6 – 7 vv. intercostales posteriores sin; into the upper direction v. hemiazygos accessoria might be communicates with v. brachiocephalica sinistra or with v. intercostalis superior sinistra, into the lower – opens into v. hemiazygos. Vv. intercostales posteriores are the most important tributaries of v. azygos, v. hemiazygos et v. hemiazygos accessoria. They drain the walls of the thoracic cavity, deep muscles of the back, plexus venosus vertebralis externus et internus. Their anterior ends communicate with vv. intercostales anteriores (v. thoracica interna). VENA CAVA INFERIOR V. cava inferior returns blood from all structures of the body below the diaphragm. It is about 14 cm long, 2 cm in diameter. V. cava inferior starts at the level of the 5th lumbar vertebra by junction of v. iliaca communis dextra et sinistra. V. cava inferior ascends anteriorly to the vertebral column and to the right according aorta. It passes the liver and lies in sulcus venae cavae, runs through foramen venae cavae and in the thoracic cavity is covered by pericardium. V. cava inferior opens into the right atrium at the level of the 8 – 9th thoracic vertebra. Anteriorly to vena cava inferior lies hepar, caput pancreatis, pars horizontalis duodeni, radix mesenterii; posteriorly to it – pars lumbalis diaphragmatis, m. psoas major dx, truncus sympathicus dx, a. renalis dx, aa. lumbales dx. V. cava inferior tributaries coud be divided into visceral and parietal groups. Visceral tributaries of v. cava inferior: V. renalis dextra et sinistra – V. renalis sinistra is longer and receives tributaries: v. suprarenalis sinistra – drains glandula suprarenalis, v. testicularis sinistra (for male) or v. ovarica sinistra (for female); V. suprarenalis dextra – drains the right suprarenal gland; V. testicularis dextra (for male) or v. ovarica dextra (for female) – they join v. cava 8 RSU Institute of Anatomy and Anthropology Vascular system, part II, veins inferior directly at the acute angle. V. testicularis or v. ovarica originates from the network of blood vessels – plexus pampiniformis. Plexus pampiniformis for male surrounds testis et epididymis and is content of funiculus spermaticus. The plexus continues till canalis inguinalis internal opening and then transforms into the vein. Plexus pampiniformis for female surrounds ovarium, lies in mesovarium and continues as the vein in lig. suspensorium ovarii. V. testicularis sinistra or v. ovarica sinistra drains the corresponding organ and joins v. renalis sinistra at the right angle; Vv. hepaticae (3 – 4) – they are short, lie in sulcus venae cavae and drain the liver. Parietal tributaries of v. cava inferior: Vv. phrenicae inferiores drain inferior surface of the diaphragm; Vv. lumbales – they are 4 pairs and drain the posterior and lateral walls of the abdominal cavity and deep muscles of the back; vv. lumbales communicate with plexus venosus vertebralis externus et internus and v. lumbalis ascendens dextra et sinistra. V. ILIACA COMMUNIS V. iliaca communis runs together with corresponding artery, it begins at the level of art. sacroiliaca by junction of v. iliaca externa and v. iliaca interna. V. ILIACA EXTERNA V. iliaca externa starts at lacuna vasorum as continuation of v. femoralis and drains the lower limb. V. iliaca externa ascends along linea terminalis and has tributaries: V. epigastrica inferior starts at the region of the umbilicus and accompanies the corresponding artery; it anastomoses with v. epigastrica superior (v. thoracica interna) and vv. paraumbilicales (v. portae); V. circumflexa ilium profunda – runs along crista iliaca, drains the abdominal and pelvic muscles in the region of crista iliaca. V. ILIACA INTERNA V. iliaca interna drains the walls and organs of the pelvic cavity; it is formed by fusion of visceral and parietal tributaries. Visceral tributaries of v. iliaca interna: 1. V. rectalis media; 2. Vv. vesicales; 3. Vv. uterinae (for females). There are group of veins, which originate from the different venous plexus of the pelvic cavity and drain the corresponding organs. Venous plexus of the pelvic cavity for male: plexus venosus rectalis; plexus venosus vesicalis; plexus venosus prostaticus. Venous plexus of the pelvic cavity for female: plexus venosus rectalis; plexus venosus vesicalis; plexus venosus uterinus; plexus venosus vaginalis. Plexus venosus rectalis lies in posterior and lateral walls of the rectum and it is drained into three directions: v. rectalis superior (1) – drains the upper part of the plexus to v. mesenterica inferior, v. rectalis media dx. et sin. (2) – drain the middle part of the plexus directly to v. iliaca interna, v. rectalis inferior dx. et sin. (2) – drain the lower part of the plexus via v. pudenda interna to v. iliaca interna. Plexus venosus vesicalis for male is fused with plexus venosus prostaticus and both together form the largest venous plexus in the pelvic cavity. Plexus venosus vesicalis is located at the base of the urinary bladder, plexus venosus prostaticus – at the lateral and posterior parts of the prostata. Plexus venosus prostaticus receives tributary – v. dorsalis profunda penis. It is the biggest vein of the penis, lies between aa. dorsales penis and drains  RSU Institute of Anatomy and Anthropology Vascular system, part II, veins 9 glans penis et corpora cavernosa penis. Plexus venosus prostaticus is drained to plexus venosus vesicalis, then via vv. vesicales to v. iliaca interna. Plexus venosus vesicalis for female surrounds fundus vesicae and urethra feminina upper part; it drains the urethra and the upper part of the vagina. This plexus receives tributary – v. dorsalis clitoridis, which drains the clitor. Plexus venosus vesicalis is drained by vv. vesicales to v. iliaca interna. Plexus venosus uterinus et plexus venosus vaginalis are developed in the lateral and posterior parts of the uterus and vagina. They drain also tuba uterina et lig. latum uteri. The plexus is drained by vv. uterinae to v. iliaca interna; 4. V. pudenda interna starts as v. profunda penis (for male) or v. profunda clitoridis (for female), and receives following tributaries, which drain the corresponding organs: v. bulbi penis (for male), v. bulbi vestibuli (for female), v. urethralis, v. perinealis, v. rectalis inferior. Parietal tributaries of v. iliaca interna: V. iliolumbalis drains posterior wall of the abdominal cavity, the abdominal and pelvic muscles; Vv. sacrales laterales ascends along facies pelvica ossis sacri and together with v. sacralis mediana forms plexus venosus sacralis, they drain abdominal muscles and pelvic lymphatic nodes; V. obturatoria drains the medial compartment of the muscles of the thigh; V. glutea superior drains m. gluteus medius et minimus, m. tensor fasciae latae; V. glutea inferior drains m. gluteus maximus. VEINS OF THE UPPER LIMB Veins of the upper limb – vv. membri superioris are v. subclavia, v. axillaris, the deep and superficial veins of upper limb. V. subclavia drains the upper limb and the shoulder girdle. V. subclavia is a direct continuation of v. axillaris at the external margin of the 1st rib. The vein lies on sulcus venae subclaviae of 1 st rib. It runs through space between m. scalenus anterior and straight muscles of the neck; behind art. sternoclavicularis it unites with v. jugularis interna and forms v. brachiocephalica. V. subclavia passes separately from the artery and has no tributaries. V. axillaris begins at the lower border of m. teres major as the continuation of brachial veins – vv. brachiales, increases in size as it ascends, and ends at the outer border of the 1st rib as the subclavian vein. The axillary vein receives the cephalic vein and its other tributaries correspond with the branches of the axillary artery. It lies on the medial side of the artery, which partly overlaps; between the artery and vein there is the medial cord of the brachial plexus. Veins of the upper limb below the axillary vein are of two groups: – vv. profundae membri superioris s. comitantes – deep veins; – vv. superficiales membri superioris s. subcutaneae – superficial veins. Vv. profundae membri superioris drain the muscles, bones and joints. They lie under the fascias, accompany the corresponding arteries and are paired. They are running from periphery to the center. The main veins are: 2 vv. radiales, 2 vv. ulnares, 2 vv. brachiales. At the region of the axillary cavity both vv. brachiales join to form one v. axillaris, which continues as v. subclavia. On the palm there are two arcs: arcus venosus palmaris superficialis et profundus. Arcus venosus palmaris superficialis lies below aponeurosis palmaris together with arterial arch; blood from it is drained into superficial and deep veins. Arcus venosus palmaris profundus accompanies the deep arterial arch and is drained into deep veins. 10 RSU Institute of Anatomy and Anthropology Vascular system, part II, veins Vv. superficiales membri superioris drain the skin and subcutaneous tissue. There are 2 main superficial veins: v. cephalica and v. basilica. V. cephalica commences from the lateral part of rete venosum dorsale manus formed by vv. metacarpales dorsales. V. cephalica winds around radial side of the hand to the anterior surface of the forearm. It ascends along sulcus bicipitalis lateralis, then lies between m. deltoideus and m. pectoralis, pierces fascia pectoralis and flows into v. axillaris. V. basilica begins from the medial part of rete venosum dorsale manus, winds around ulnar side of the hand to the anterior surface of the forearm. Then it ascends along sulcus bicipitalis medialis, pierces fascia brachialis at the middle third of the brachium and joins to one of the deep veins – v. brachialis. V. cephalica and v. basilica are communicated in the region of fossa cubitalis by v. mediana cubiti. Sometimes between v. cephalica and v. basilica runs a superficial vein – v. mediana antebrachii. VEINS OF THE LOWER LIMB Veins of the lower limb – vv. membri inferioris are divided into two groups: vv. profundae and vv. superficiales membri inferioris. Vv. profundae membri inferioris drain muscles, bones and joints. They lie under fascias and accompany the corresponding arteries. The deep veins of the foot and the lower leg are paired – 2 vv. tibiales anteriores and 2 vv. tibiales posteriores join to form one v. poplitea. V. poplitea lies in fossa poplitea posteriorly and laterally to a. poplitea and continues into v. femoralis. V. femoralis ascends, runs through lacuna vasorum and in pelvic cavity continues as v. iliaca extern