Anatomy Dissections: Vessels of the Limbs

Introduction to Blood Vessels and Circulation


  • Blood vessels are classified by Size and Histological organization


  • Blood vessels are instrumental in Cardiovascular Regulation


  • The largest blood vessels attach to the Heart.


  • These are:
  1. Pulmonary Trunk which carries deoxygenated blood from the Right Ventricle to the Pulmonary Circulation


  1. Aorta which carries oxygenated blood from the Left ventricle to the Systemic Circulation



The Differences between the types of Blood Vessels: Arteries and Veins


Differentiate between Arteries and Veins


  1. Arteries have thicker walls and a higher blood pressure than Veins



  1. Structure

  • A constricted Artery has a small, round lumen


  • A Vein has a large, irregular lumen, and can easily collapse unless filled with a clot




  1. The Endothelium of a constricted Artery is folded


  1. Arteries are MORE Elastic than Veins


  1. Veins have Valves and Arteries do not have Valves

Structure and Function of Arteries


Outline the Structure and Function of Arteries


  • Arteries have Elasticity and Contractility


  1. Elasticity allows arteries to absorb pressure waves that come with each heartbeat


  1. Contractility
  • Under the control of the sympathetic division of the Autonomic Nervous System (ANS), Contractility allows Arteries to change their diameter through Vasoconstriction or Vasodilation


  • Vasocontraction is the contraction of the arterial smooth muscles


  • Resulting in the narrowing of the arterial lumen


  • Vasodilation is the relaxation of the arterial smooth muscle


  • Resulting in an enlarged arterial lumen


  1. Vasoconstriction and Vasodilation of the Arteries affect the:


  • Afterload on the Heart


  • Peripheral blood pressure


  • Capillary blood flow





**Increased systemic vascular resistance (Vasoconstriction) increases the afterload


Reduced vascular resistance (vasodilation) decreases the Afterload

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Structure and Function of Capillaries


Define Collaterals, Arterial Anastomosis, and Arteriovenous Anastomoses


  1. Collaterals are multiple arteries that contribute to one capillary bed
  • This allows for continued circulation if one artery is blocked


  1. Arterial anastomosis is the fusion of two collateral arteries


  1. Arteriovenous anastomoses is the direct connections between arterioles and venules
  • Bypassing the capillary bed


Blood vessels: Distribution of Blood


  • The distribution of blood is:



    • 30-35% of blood volume goes to the Heart, Arteries and Capillaries


    • 60-70% goes to the Venous System of which one third of venous blood is in large venous networks of the Liver, Bone marrow and Skin

Cardiovascular Adaptation


Describe Cardiovascular Adaptation


  1. Blood, Heart and Cardiovascular System
  • Work together as a unit


  • Respond to physical and physiological changes (eg: Exercise and Blood loss)


  • Maintain homeostasis


  1. Vascular supply to special regions allows some organs to have separate mechanisms to control blood flow


  • Three important examples:
  1. Brain
  2. Heart
  3. Lungs

Arteries of the Upper Limb: Right Limb with Forearm supinated, Anterior View


Outline the Arteries of the Right Upper, and Anterior Limb


  1. Left ventricle gives rise to the Ascending Aorta, which becomes the Aortic Arch


  1. The Aortic Arch splits into 3 different branches:
  • Left Subclavian artery
  • Left Common Carotid artery
  • Brachiocephalic Trunk


  1. The Brachiocephalic Trunk gives rises to 2 other Arteries
  • Right Common Carotid artery
  • Right Subclavian artery


  • The Subclavian arteries supply blood to the arms, chest wall, shoulders, back and CNS


  • They give rise to the:



    • Internal Thoracic artery
    • Vertebral artery
    • Thyrocervical trunk


  1. The Right Subclavian artery becomes the Right Axillary artery once it enters the Axilla


  1. The Axillary artery exits the Right Axilla and becomes the Right Brachial artery


  1. Right Brachial artery splits into the:
  • Right Ulnar and Right Radial arteries


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Outline the formation of the Ulnar and Radial arteries from the Brachial Artery


  • Before the Brachial artery splits into 2 main branches, on either side (medial and lateral) of the Brachial artery are the following branches


  1. On the Medial side (Ulnar side) there is the Superior and Inferior Ulnar Collateral Branches.


  • Superior Ulnar Collateral branch forms the
    Posterior Ulnar Recurrent Branch


  • Inferior Ulnar Collateral Branch forms the Anterior Ulnar Recurrent Branch


  • These Branches then anastomoses with the Brachial Artery to form the Ulnar Artery



  1. On the Lateral side (Radial side) there is a Radial Recurrent artery


  • The Radial recurrent artery then anastomoses with the brachial artery to form the Radial artery


  • These branches of the Brachial, Radial and Ulnar arteries supply the elbow joint



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Outline the Radial and Ulnar Artery


  • The Brachial artery usually divides at the Cubital Fossa of the Humerus into the:

  1. Radial Artery supplies the forearm and radial side


  2. Ulnar Artery supplies the forearm and ulnar side




  • Radial and Ulnar arteries have an overlap within the palm of the hands



    • Ulnar artery is a major contributor to the Superficial Palmar arc


    • Radial artery is a major contributor to the Deep Palmar arch




  • The radial and ulnar arteries are connected by anastomoses of the Palmar arches that supply the Digital Arteries


  • Other important arteries are the:

  1. Anterior Ulnar recurrent artery


  2. Posterior Ulnar recurrent artery


  • These two arteries are important for blood supply around the elbow joint.



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The Upper and Superficial Veins of the Upper Limb


  • Skin of the Upper Limb is drained by the Cephalic and Basilic veins

Outline the development of the Axillary Artery


The Axillary Artery


  • Subclavian Artery comes off the Brachiocephalic Trunk, and passes beneath the Clavicle to enter the Axilla


  • At the Lateral border of the 1st Rib, the Subclavian artery is now the Axillary artery


  • The Axillary artery is split into 3 parts by the Pectoralis Minor Muscle



Define the 3 Parts of the Axillary Artery (Some Times Life Seems A Pain)



  1. 1st part is made up of the Superior Thoracic Branch



    • First part of the Axillary artery is before the Pectoralis minor muscle


  1. 2nd Part is made up of the Thoracoacromial Branch, Lateral Thoracic Branch,



    • 2nd part of the Axillary artery is below the Pectoralis minor muscle


  • These branches supply the Chest wall and Shoulder region from the 2nd part of the Artery


  1. 3rd part is made up of the Anterior and Posterior Circumflex Humeral Branches and Subscapular Artery, as they pass through the Humerus


  • The Posterior Circumflex Humeral branch enters the Deltoid muscle with the Axillary nerve



    • 3rd part of the Axillary artery is after the Pectoralis minor muscle


  • The Largest branch of the Axillary artery is the Subscapular artery which descends along the Lateral Border of the Scapula


  • Circumflex Scapular branch anastomoses with the Suprascapular and Dorsal Scapular branches of the Subclavian artery


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Outline the Axillary Artery after it becomes the Brachial Artery


  • The Axillary artery will become the Brachial artery once it passes the Lower Border of the Teres Major muscles


  • Profundi Brachii artery passes Posteriorly to the back of the arm with the Radial Nerve, between the Medial and Lateral heads of the Triceps Brachii muscles


  • There are Venae comitantes on either side of the Brachial artery and Profundi Brachii artery



    • These Veins drain the deep structures of the arms.


  • At the Cubital fossa the the Brachial artery divides into 2 main branches:
  1. Radial artery


  1. Ulnar artery



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The Ulnar and Radial Arteries


Outline the further development of the Ulnar and Radial arteries


  • In the cubital fossa, the Ulnar artery gives rise to the Common Interosseous Artery


  • The Common Interosseous artery gives rise to the:

  1. Anterior Interosseous artery


  2. Posterior Interosseous artery



    • Which run on either side of the of the Interosseous membrane with the Anterior and Posterior (Radial) Interosseous nerves


  • Ulnar artery then passes beneath the Flexor carpi Ulnaris with the Ulnar nerve to the wrist


  • Ulnar artery crosses Superficial to the Flexor Retinaculum with the Ulnar nerve to enter the Palm where is forms the Superficial Palmar Arch



    • Superficial Palmar Arch is completed laterally by a branch from the Radial artery



  • Radial artery crosses to the Dorsolateral aspect of the hand.


  • It passes through the Anatomical Snuff Box between the Abductor Pollicis longus and Extensor Pollicis longus and Brevis muscle


  • Before entering the Anatomical Snuff Box, the Radial artery gives rise to the lateral branch that completes the Superficial Palmar Arch


  • Radial artery then enters the Palm between the 2 heads of the 1st and 2nd Dorsal Interosseous muscles to form the Deep Palmar Arch



    • Deep Palmar arch lies on the Metacarpal Bases


    • A branch from the Ulnar Artery completes the Deep Palmar Arch





  • Radial and Ulnar arteries are accompanied by Venae comitantes


  • These Veins drain the deep structures of the Forearm, and join the Veins around the Brachial artery to form the Axillary Vein which in turn forms the Subclavian Vein



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Superficial Veins of the Lower Limb


Describe the Superficial Veins of the Upper Limb



  • Skin of the lower limbs is drained by the Great and Small Saphenous Veins


Provide a brief overview of the Arteries of the Lower Limbs



Arteries of the Pelvis and Limb


  • The Descending Aorta becomes the Median Sacral Artery


  • The Sacral Artery then splits into the Right and Left Common Iliac Arteries


  • Right and Left Common Arteries gives rise to:


  1. Internal Iliac Artery


  1. External Iliac Artery


  • External Iliac Artery then becomes a Femoral Artery


  • Femoral Artery gives rise to the Deep Femoral Artery



    • Deep Femoral artery gives rise to the Lateral Femoral Circumflex Artery and Medial Femoral Circumflex Artery


  • Femoral Artery then gives rise to the Descending Genicular (Joints) artery that supplies the Knee Joint


  • Femoral artery becomes the Popliteal Artery positioned Posterior to the Knee


  • Popliteal Artery then branches before reaching the Lower Leg to form the:


  1. Posterior Tibial Arteries


  1. Anterior Tibial Arteries


  • Anterior and Posterior Tibial Arteries are separated by an Interosseous membrane


  • Interosseous membrane is located between the Tibia and Fibula



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The Femoral Artery


Outline the Formation of the Femoral Artery


  • The arterial supply of the Lower Limb is derived from the External Iliac Artery


  • Once the External Iliac Artery passes beneath The Inguinal Ligament to enter the Femoral Triangle, It becomes the Femoral Artery


  • Before entering the Femoral Triangle the External Iliac Artery gives rise to 2 branches called:


  1. Inferior Epigastric Artery


  1. Deep Circumflex Iliac Artery



  • The Femoral artery will the enter the Femoral Triangle in the thigh


  • In the Femoral Triangle the Femoral Artery gives rise to the Deep Femoral Artery or the Profunda Femoris


  • Deep Femoral Artery supplies the back of the thigh, and gives rise to numerous perforating branches to the Adductor and Hamstring muscles


  • The Deep Femoral Artery (Profunda femoris) gives rise to the Medial Circumflex Femoral Branch and Lateral Circumflex Femoral Branch


  • The Lateral and Medial Circumflex Femoral Arteries supply the Upper Thigh Muscles


  • And anastomoses with the Inferior Gluteal Vessels of the Pelvis to supply the Hip Joint


Outline the structures of the Femoral triangle


  • In the Femoral Triangle from the Lateral to the Medial Side are the following structures:

  1. Femoral Nerve


  2. Femoral Artery


  3. Femoral Vein



The borders of the Femoral Triangle are made up of the:


  1. Inguinal Ligament


  2. Sartorius


  3. Adductor Longus




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Popliteal Artery


Outline the formation of the Popliteal Artery


  • Femoral Artery enters through the Adductor Canal to the Adductor Hiatus where it passes to the back of the thigh


  • Once the Femoral Artery enters the Popliteal Fossa it becomes the Popliteal Artery



    • Popliteal Artery is accompanied by the Popliteal Vein and Tibial nerve



Outline the structures making up the Borders of the Popliteal Fossa


  • Upper Lateral Border is made up of the Biceps Femoris


  • Upper Medial Border is made of the Semimembranosus




  • Lower Lateral Border is made up of the Lateral head of the Gastrocnemius Muscle



  • Lower Medial Border is made up of the Medial Head of the Gastrocnemius Muscle



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The Anterior and Posterior Tibial Arteries


Outline the formation of the Anterior and Posterior Tibial Arteries



  • Once the Popliteal Artery exists the Popliteal Fossa, it splits into 2 branches with one on either side of the Interossei membrane:


  1. Anterior Tibial Artery


  2. Posterior Tibial Artery




  • Anterior Tibial Artery supplies the anterior regions of the leg


  • Posterior Tibial Artery supplies the posterior regions of the leg


  • The Anterior and Posterior Tibial Arteries are accompanied by Venae comitantes and these Venae Comitantes fuse to form the Popliteal Vein



    • Small Saphenous vein joins the popliteal vein


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Describe the development of the Posterior Tibial Artery


  • The Posterior Tibial artery accompanies the Tibial Nerve through the Posterior Compartment


  • The Posterior Tibial artery passes between the two heads of the Gastrocnemius Muscle to the deep layer of the leg


  • The Posterior Tibial Artery gives rise to the Fibular Branch (Fibular Artery)



  • The Fibular Artery supplies the Lateral (Fibular) Compartment of the Lower leg


  • The Posterior Tibial artery then descends between the Flexor Hallucis longus and Tibialis Posterior muscle



  • The Posterior Tibial artery passes the Medial Malleolus between the Tendons of the Deep Muscles


  • The Posterior Tibial artery forms the Medial Plantar Arteries and Lateral Planter Arteries in the Foot


  • Medial Plantar Arteries and Lateral Planter Arteries supply the structurers of the foot


  • These arteries supply the Plantar Side of the foot, and contributes to the supply of the toes via the Deep Plantar Arch.


  • These structures are accompanied by the Medial Plantar Nerves and Lateral Plantar Nerves


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Describe the Development of the Anterior Tibial Artery



  • Anterior Tibial artery becomes the Dorsalis Pedis Artery as it enters the Dorsum of the Foot



  • Dorsalis pedis artery supplies Digital Branches to the Toes


  • Anastomoses with the Lateral Plantar Artery of the Sole of the Foot in the space between the 1st and 2nd Metatarsals to form the Deep Palmar Arch


  • Medial Plantar Arteries and Lateral Planter Arteries connect to the Dorsalis Pedis Artery to form the Dorsal Arch and Plantar Arch


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Systemic Veins


  • Complementary arteries and veins run side by side


  • Branching patterns of Peripheral Veins are variable


Veins of the Neck and Limbs


Outline the veins of the Neck and Limbs


  • In the Neck and the Limbs there is One set of Arteries and Two sets of Veins (One Deep and One Superficial)\


  • The Venous system controls the Body temperature


Veins of the Hand


Outline the veins of the Hands from Distal to proximal


  • Veins of the Hands are called Digital veins


  • Digital veins empty into the Superficial Palmar Veins and Deep Palmar Veins


  • Which interconnect to form the Palmar Venous Arches


  • Superficial Palmar Venous Arch empties into the:
  1. Cephalic Vein of the Forearm


  1. Median Antebrachial Vein


  1. Basilic Vein of the Forearm


  1. Median Cubital vein


  • Deep Palmar veins drain into the:
  1. Radial and Ulnar veins


  • Which fuse above the elbow to form the Brachial Vein



  • Brachial Vein merges with the Basilic Vein to become the Axillary Vein


  • Cephalic vein joins the Axillary Vein to form the Subclavian Vein


  • Subclavian Vein merges with the External Jugular vein and Internal Jugular Vein to form the Brachiocephalic Vein


  • Brachiocephalic Vein enters the Thoracic Cavity



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NOTE:


  • Cephalic Vein drains the Radial Side of the Dorsal venous Arch


  • Basilic Vein drains the Ulnar Side of the Dorsal Venous Arch


  • The flow of deoxygenated blood in the Lower Limbs is from the Superficial Veins which then drain into the Deep Veins


  • Median Cubital Veins is the vein selected for Venipuncture, because the Cephalic veins is not easily visible

Veins of the Foot


Outline the Veins of the Foot and the Lower Leg


  1. Capillaries of the Sole of the foot drain into the Network of Plantar Veins which supply the Plantar Venous Arch


  • Plantar Venous Arch then drains into the Deep Veins of the Leg which are the:

  1. Anterior Tibial Vein


  2. Posterior Tibial Vein


  3. Fibular Vein




  • The three Deep Veins of the Leg join to become the Popliteal Vein


  1. Dorsal venous Arch collect blood from the Superior Surface of the Foot and the Digital veins


  • Dorsal Venous Arch then drains into the Two Superficial Veins which are the:
  1. Great Saphenous Vein
  • Great Saphenous Vein drains into the Femoral vein


  1. Small Saphenous vein drains into the Popliteal vein




  1. Popliteal vein then becomes the Femoral vein when exiting the Popliteal fossa


  • The Femoral Vein before entering the Abdominal Wall receives blood from the:

  1. Great Saphenous vein


  2. Deep femoral vein


  3. Femoral; Circumflex Vein




  • Once inside the Pelvic Cavity, the Femoral Vein becomes the External Iliac vein


  • External Iliac vein then fuses with the Internal Iliac vein to form the Common Iliac vein

Branches of the Axillary Artery


Mnemonic: Some Times Life Seems A Pain


S: Superior Thoracic branch
T: Thoracoacromial branch
L: Lateral Thoracic branch
S: Subscapular
A: Anterior Circumflex Humeral artery
P: Posterior Circumflex Humeral artery

Heart Structures seen on an X-Ray


List the Heart Structures seen on an X-Ray


  • Aortic Arch


  • Ascending Aorta


  • Right Pulmonary Artery


  • Right Atrium


  • Descending Aorta


  • Left ventricle


  • Left Atrium


  • Left Pulmonary Artery


  • Aortopulmonary window


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The main structure contributing to the left heart border shadow in a normal chest x-ray is formed by which structure ?


  • Left Ventricle and left Atrial Appendage



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Interpreting the Chest X-ray


Explain the Interpretation of the Chest X-Ray


  • X-ray is a film that is looking at material hitting the film and causing it to be Dark or White


  • X-ray can display a variety of shades depending on the density of the Material:


  1. Black: Air
  • Example: Lungs


  1. Dark Grey: Fat or Subcutaneous Tissue
  • Example: Fat


  1. Light Grey: Soft Tissue
  • Example: The Heart and Blood vessels


  1. Off White: Bone
  • Example: Ribs and Clavicle


  1. Bright White: Metal
  • Example: Pacemaker



  • Due to the different densities of objects next to each other. A clear demarcation will indicate the border at the interface of the two objects

There are 2 ways of shooting an X-Ray


Explain how to shoot an X-Ray


  • There are 2 ways of shooting an X-Ray


  • Depending on where the board that collects the X-ray is place


  1. Shooting the film from Front to Back

  • This is known as an Anterior-Posterior (AP)



    • Board is placed behind the patient


  • AP Method is not the best method because this view is susceptible to artificial magnification of the Heart and Blood vessels



  1. Shooting the film from Back to Front

  • This is known as a Posterior-Anterior (PA)



    • Board is placed in front of the patient


  • The PA method is better, because the Heart and the Other Objects are closer to the Board


  • Therefore, less artificial increase in size


  • A Lateral Film in the PA Method is also done


  • This is a side view, which gives Three Dimensions on an X-Ray and gives a better location of the Objects



  1. Normally, a patient is asked to take a deep breath in when shooting an X-Ray Film
  • This to accentuate very well the different areas of the Lungs


  • However, there can also be an Exhalation Film.


  • This is done when wanting to look for a Pneumothorax or Air-Trapping


  • These will be accentuated on Exhalation

Steps to Follow when inspecting a Chest X-Ray



A. Inspect the Trachea and it's branches


  • When inspecting the Trachea make sure that the trachea is not being shifted to either the Left or Right Side


  • This could be a sign of Pleural Effusion or Atelectasis


  • Pleural Effusion pushes the Trachea to the opposite side of the affected Lung


  • Whereas, Atelectasis (a collapse of the Lung) will pull the Trachea to the affected Lung


B. Inspect the Bone


  • When inspecting and comparing the Bone Structures you look at the following:



    • Site
    • Size
    • Shape
    • Shadows
    • Borders
    • Fractures


  • Horizontal Ribs are the Posterior aspect of the Ribs


  • Descending Ribs are the Anterior aspect of the Ribs


  • Inspect if the Spinous Processes are lined up and along the edge to inspects for Compression Fractures


  • Lytic lesions which are like holes that have Air-density inside of Bone-density