Vasculature Of The Upper Extremity

Front 1

collateral

Back 1

Collateral circulation = alternate pathways of blood flow.

Note that arteries do not have any valves (except next to the heart) so blood can flow “backwards” in some areas to back-supply a region which has it’s primary route blocked. Some loops also exist in body. Critical to know in surgery – can’t tie off an artery that services an area which has no collateral supply. Also, these loops can mask a blockage – a blockage might occur but no one notices because collateral circulation system remodels to become the new primary route and the blocked route fades away.

End-artery: Sole vascular supply to an area of tissue (e.g. no collateral circulation to these areas). Brain, heart, and kidney have these but otherwise they are fairly rare. (In brain, the terminals are after the “ring”.) NEED TO KNOW WHERE THEY ARE BECAUSE OF CONSEQUENCES OF BLOCKS IN THEM.

Front 2

what comes off of the subclavian artery?

Back 2

Vertebral artery comes off of the subclavian.
Internal thoracic (runs INSIDE the chest cavity) comes off of the subclavian.
Thyrocervical Trunk comes off of subclavian:
Inferior Thyroidal A. (1/2 of one side’s supply to thyroid.)‏
Transverse cervical A.
Dorsal scapular A. (33%)‏
Suprascapular A.
Costocervical TR.
Deep cervical A.
Dorsal scapular A. (67%)‏

Note name change of subclavian to axillary as it crosses the 1st rib.

Hint 2

-vertebral
-internal thoracic
-thyrocervical trunk
-inferior thyroidal artery
-transverse cervical artery
-dorsal scapular artery (33%)
-suprascapular artery-costocervical trunk
-deep cervical artery
-dorsal scapular artery

Front 3

axillary artery
1st part

Back 3

-thoracromial artery

Front 4

axillary artery
2nd part
-lateral throacic artery

Back 4

runs on top of serratus anterior next to nerve. Supplies serratus on it’s way. Also supplies breast in part.
[Circumflex means to wrap around. Common term in vascular system.]

Front 5

axillary artery
-post. and ant. circumflex humeral artery

Back 5

wrap around the surgerical neck of humerus. They meet on lateral side of humerus. A collateral route. Feeds deltoid and has a descending branch. Posterior passes through a “quadangular space” (teres major & minor and two heads of triceps) along with the axillary nerve. KNOW YOUR LANDMARKS – THAT’S WHAT HELPS YOU FIND THE STRUCTURES IN A VARIABLE BODY.

Front 6

axillary artery summary

Back 6

THORACO-ACROMIAL A.
LAT. THORACIC A.
POST. CIRCUMFLEX HUMERAL A.
ANT. CIRCUMFLEX HUMERAL A.
SUBSCAPULAR A.
BRACHIAL A.

Front 7

anastomoses

Back 7

SUPRASCAPULAR A.
THORACOACROMIAL A.
SUBSCAPULAR A.
CIRCUMFLEX SCAPULAR A.
DORSAL SCAPULAR A.
INTERCOSTAL AA.

Front 8

anastomoses around scapula
-suprascap-->?

Back 8

suprascapular->supplies
1.supraspinatus
2.infraspinatus
3.connects w/subscapular a. via circumflex scap a.

Front 9

anastomoses around scap on anterior side

Back 9

-dorsal scap. connects with other arteries
-intercostal arteries connect too

Front 10

branches off of the brachial artery

Back 10

PROFUNDA BRACHII
DELTOID BR. (a.k.a. Ascending BR.)‏Descending branch from circumflex humeral A. (from above) forms an anastomose with ascending (deltoid) branch of profunda.
MUSCULAR BRS.
profunda ends as it splits to:
MEDIAL COLLATERAL A. (POST. BR.)‏
RADIAL COLLATERAL A. (ANT. BR.)‏

Front 11

brachial artery supplies which compartment and ends in a split -->

Back 11

Brachial artery supplies anterior compartment.

Ends in a split (bifurcating) into radial & ulnar A. distal to the elbow.

Front 12

off of profunda, these are collateral branches that serve posterior compartment

Back 12

Superior ulnar collateral passes posterior to condyle while inferior passes anterior to condyle.

Front 13

1st route around elbow

Back 13

radial recurrent anastomoses with radial collateral (off of profunda)

Front 14

ulnar artery
2nd route and 3rd route

Back 14

Anterior ulnar recurrent artery -->inferior ulnar collateral. (2nd route around elbow.)‏
Posterior ulnar recurrent artery --> posterior side of medial condyle & meets with superior ulnar collateral. (3rd route around elbow.)‏

Front 15

4th route around elbow of ulnar artery

Back 15

‏Common interosseous artery – divides almost immediately into anterior & posterior; anterior stays on anterior side of membrane, supplying membrane itself and deep flexors of forearm. Posterior goes through tiny hole to supply posterior compartment deep muscles. Interosseous recurrent artery – branches from one or the other – passes posteriorally and connects with medial collateral. (4th route around elbow.)‏

Front 16

venae comitantes are? and give way to what vein?

Back 16

Deep veins are mostly called “venae comitantes” – companion veins. Form network around arteries they run with.

Midway up the humerus (give or take) a single vein forms – the brachial vein. These are the deep veins – arterial in reverse except for common name for smaller veins.

Front 17

brachial vein becomes axillary upon crossing what muscle?

Back 17

Superficial veins. At about mid-arm, goes deep to become the brachial vein and receives the venae commitantes which drain into it.

Brachial V. becomes the axillary V. upon crossing teres major.

Front 18

medial superficial vein drains into?

Back 18

MEDIAL SUPERFICIAL VEIN
DRAINS INTO:
BRACHIAL VEIN
AXILLARY VEIN

Front 19

the cephalic vein drains into what vein? axillary becomes what vein?

Back 19

drains into axillary
axillary becomes subclavian vein

Front 20

subclavian vein

Back 20

RECEIVES:
EXTERNAL JUGULAR VEIN
INTERNAL THORACIC VEIN
RIGHT LYMPH DUCT OR THE THORACIC DUCT
DRAINS INTO:
BRACHIOCEPHALIC VEIN

Front 21

cephalic vein

Back 21

LATERAL VEIN
DELTOPECTORAL TRIANGLE
CLAVIPECTORAL FASCIA
DRAINS INTO:
AXILLARY VEIN

Front 22

median cubital vein

Back 22

INTER-CONNECTS BASILIC AND CEPHALIC VEINS

There are always collateral routes in veins BUT remember that the veins of the limbs do have valves. Skeletal muscle pump used to aid in flow.