بسم الله الرحمن الرحيم سَنُرِيهِمْ آيَاتِنَا فِي الْآفَاقِ وَفِي أَنفُسِهِمْ حَتَّى يَتَبَيَّنَ لَهُمْ أَنَّهُ الْحَقُّ } أَوَلَمْ يَكْفِ بِرَبِّكَ أَنَّهُ عَلَى كُلِّ شَيْءٍ شَهِيدٌ... } فصلت 53

Blood vessels of upper and lower limbs By Dr . Rasha sabry

Subclavian artery Origin of the Right subclavian artery : It arises from the brachiocephalic artery behind the right sternoclavicular joint . Origin of the left subclavian artery : It arises from the arch of aorta . Termination : Both right and left arteries end at the outer border of the 1st rib to be continues as the axillary artery .

Subclavian artery Course : It has an arched course across the root of the neck It is divided into three parts by the scalenus anterior muscle .

Branches of the 1st part of subclavian artery

Branches of the 2nd part of subclavian artery Costocervical trunk Deep cervical artery superior intercostal artery

Branches of the 3rd part Surface anatomy of subclavian artery : NO BRANCHES But in about 2/3 of cases it may give rise to dorsal scapular artery Surface anatomy of subclavian artery : It is represented by a curved line with an upward convexity , drawn from the sternoclavicular joint to the midpoint of the clavicle , Its highest point is 1 inch above the clavicle

Axillary artery 1- Origin : continuation of subclavian artery at the outer border of the first rib . Course : the artery is divided by pectoralis minor muscle into 3 parts . Termination : At the lower border of teres major muscle where it continues into the arm as the brachial artery .

Profundabrachii artery Axillary artery Profundabrachii artery Brachial artery

Branches of the axillary artery 1-Branches of the first part : It gives one branch : superior thoracic artery . Branches of the 2nd part of axillary artery It gives 2 branches : 1- Thoracoacromial artery 2- lateral thoracic artery

Branchesof the 3rd part of axillary artery It gives 3 branches : 1- Anterior circumflex humeral artery . 2- Posterior circumflex humeral artery . 3- Subscapular artery

Brachial artery Origin :It is the continuation of the axillary artery at the lower border of the teres major muscle . Termination : It terminates opposite the neck of radius by dividing into radial and ulnar arteries in the cubital fossa .

Aillary artery Brachial artery

Anterior view of upper limb Radial artery Brachial artery Ulnar artery Anterior interosseous artery

Branches of the brachial artery 1- Profunda brachii artery . (It is the main source of blood supply to posterior compartment of the arm .) 2- Superior ulnar collateral artery . 3- Inferior ulnar collateral artery . 4- Muscular branches . 5- Nutrient artery of the humerus .

Profunda brachii artery Posterior interosseous artery Posterior view of upper limb Dorsal carpal arch

Surface anatomy of axillary and brachial arteries Abduct the arm to a right angle and rotate it laterally so that the palm of the hand is directed upwards. Draw a line from the midclavicular point to the midelbow point (midway between the two humeral epicondyles ), This line passes on the lateral wall of the axilla at the junction of its anterior third with the posterior two thirds . The part of the line proximal to the posterior fold of the axilla represents the axillary artery . While the part distal to it represents the brachial artery .

The anatomical snuff box Radial artery Origin :It is the smaller of two terminal branches of the brachial artery at the level of the neck of radius . It is closely accompanied by two venae comitants . It enters the hand by passing through the anatomical snuff box . The anatomical snuff box

Branches of the radial artery In the forearm : 1- Radial recurrent artery . 2- Superficial palmar branch . 3- Palmar carpal branch . 4- muscular branches .

Brachial artery (its division into 2 terminal branches ) Radial artery

Branches of the radial artery In the dorsum of the hand : 1- dorsal carpal branch . 2- dorsal digital artery of the lateral side of the thumb . 3- first dorsal metacarpal artery . Dorsal carpal branch unites with dorsal carpal branch of ulnar artery to form dorsal carpal arch deep to extensor tendons

Deep palmar arch It is the terminal continuation of the radial artery in the palm . The medial end is joined by the deep branch of the ulnar artery to complete the arch . Branches : 1- Three palmar metacarpal arteries . 2- Perforating arteries . 3-Recurrent arteries .

Dorsal carpal arch Branches: 1- 2nd &3rd and 4th dorsal metacarpal arteries . 2-Dorsal digital artery for the medial side of the little finger .

Surface anatomy of the radial artery The radial artery can be represented by a line from the midelbow point (midway between the two humeral epicondyles ) to a point just above the wrist close to the lateral side of the tendon of the flexor carpi radialis .

Ulnar artery Origin : it is the larger of two terminal branches of the brachial artery . It takes origin in the cubital fossa at the level of the neck of radius . It enters the hand by passing superficial to the flexor retinaculum .

Surface anatomy of ulnar artery In the lower two thirds of the forearm , The ulnar artery corresponds to the lower two thirds of a line from the medial epicondyle to a point just lateral to the pisiform bone . The upper one third is oblique line from the midelbow point to join the vertical line .

Branches of the ulnar artery In the forearm : 1- Anterior ulnar recurrent artery . 2- posterior ulnar recurrent artery . 3- common interosseous artey . 4- palmar carpal branch . 5- dorsal carpal branch . 6- muscular branches .

Common interosseous artery Origin : Arises from ulnar artery just below radial tuberosity . At the upper border of the interosseous membrane . It divides into anterior and posterior interosseous arteries

Branches of the ulnar artery In the hand : 1- deep branch .(It anastmoses with the termination of the radial artery , thus completing the deep palmar arch ) 2- it forms the superficial palmar arch

Superficial palmar arch It is the continuation of the ulnar artery . It lies superficial to branches of median nerve ,long flexor tendons and lumbrical muscles . Branches : 1- Palmar digital artery of the medial side of the little finger . 2- Three common palmar digital arteries .

Arterial arches of the hand There are four arterial arches in the hand . 1- Dorsal carpal arch 2- palmar carpal arch 3- superficial palmar arch . (the continuation of the ulnar artery ). 4- deep palmar arch (the continuation of the radial artery )

Surface anatomy of arterial arches The superficial palmar arch lies at the level of the lower border of the outstretched thumb , while the deep palmar arch lies one cm above the superficial arch

Superficial veins of the upper limb There is a dorsal venous network in the superficial fascia of the dorsum of the hand . T he lateral end of the network is joined by the dorsal digital veins of the radial side of the index finger to form the cephalic vein . While the medial end of the network unites with the dorsal digital vein of the little finger to form the Basilic vein .

Basilic vein Median cubital vein Cephalic vein

Bicipital aponeurosis separate median cubital vein from the brachial artery

Axillary vein Origin : is the continuation of the basilic vein at the lower border of the teres major muscle . It ascends on the medial side of the axillary artery . Termination : At the outer border of the 1st rib , it continues into the neck as subclavian vein . Tributaries : 1- Veins corresponding to the branches of the axillary artery . 2-Two venae comitantes of the brachial artery . 3- Cephalic vein .

Blood vessels of the lower limb

Femoral a Popliteal a Perforating Anterior Posterior arteries tibial a tibial aa dorsalis med/lat pedis plantar a Perforating arteries

Femoral artery Origin : It is the continuation of the external iliac artery at the midinguinal point behind the inguinal ligament . Termination : A hand-breadth above the adductor tubrcle by passing through the hiatus in adductor magnus to become the popliteal artery .

External iliac artery Femoral artery Femoral vein

Surface anatomy of femoral artery The femoral artery is represented by the upper two thirds of the line connecting the midinguinal point (a point midway between symphisis pubis and anterior superior iliac spine) and adductor tubercle when the thigh is : 1- slightly flexed 2- slightly abducted 3- slightly laterally rotated

Contents of Femoral Triangle Lateral cutaneous nerve of thigh Femoral n. Deep inguinal LN Femoral v. Femoral a. Contents of Femoral Triangle

Branches of the femoral artery

Contents of Femoral Triangle Medial circumflex a. Profunda femoral a. Latral circumflex a. Contents of Femoral Triangle

Adductor canal (subsartorial canal) Profunda femoral vessels saphenous n. Adductor longus Femoral vessels n. To vastus medialis Adductor magnus vastus medialis

Branches of profunda femoris artery

Popliteal artery 1- Anterior tibial artery 2-Posterior tibial artery Origin : It is the continuation of the femoral artery at the tendinous opening in adductor magnus . Termination : It ends at the distal border of the popliteus muscle by dividing into t w o terminal branches : 1- Anterior tibial artery 2-Posterior tibial artery

Adductor magnus Popliteal artery Popliteal vein Adductor opening Small saphenous vein Tibial nerve

Popliteal artery

Branches of the popliteal artery 1- Articular branches : 1- superior lateral genicular artery 2- -superior medial genicular artery 3- middle genicular artery 4-inferior lateral genicular artery 5- inferior medial genicular artery 2- 3- Articular branches: Muscular branches Cutaneous branches

Branches

Surface anatomy of popliteal artery : It extends from the junction of the middle and lower thirds of the thigh 2.5 cm medial to its posterior midline to the midpoint between femoral condyles , continuing inferlaterally to the level of tibial tuberosity , medial to fibular neck .

Here is representative arteriogram of the lower limbs Here is representative arteriogram of the lower limbs. Showing the popliteal, AT, tibial peroneal trunk. And PT/peroneal vessels is representative arteriogram of the lower limbs. Showing the popliteal, AT, tibeal/peroneal trunk. And PT/peroneal vessels

Anterior tibial artery Origin : It is one of the t wo terminal branches of the popliteal artery at the distal border of the popliteus muscle . Termination : In front of the anckle joint mid way betw een the two malleolli to continue as the dorsalis pedis artery .

Origin Course Relation end

Branches of the anterior tibial artery

Branches of anterior tibial artery

Dorsalis pedis artery Origin : It is the continuation of the anterior tibial artery in front of the anckle joint midway between the two malleoli . Termination : In the sole of the foot by anastmosing with the medial end of the plantar arch .

Surface anatomy Dorsalis pedis artery

Surface anatomy of dorsalis pedis artery It corresponds to a line from a point on the front of the ankle midway between both malleoli to a point on the proximal end of the first interosseous space . This line runs along the first interdigital cleft .

Branches of dorsalis pedis artery 1- Medial and lateral tarsal arteries 2- Arcuate artery . 3- First dorsal metatarsal artery 4- First plantar metatarsal artery .

Branches of dorsalis pedis artery

Posterior tibial artery Origin : The large of the two terminal branches of the popliteal artery at the distal border of the popliteus . Termination : The artery ends deep to the flexor retinaculum , midway between the medial malleolus and the medial tubercle of calcaneous , it divides into two terminal branches : 1- the medial plantar atery 2- the lateral plantar artery

Posterior tibial artery Flexor digitorum longus Soleus Tibialis posterior Flexor digitorum longus Post. Surface of tibia Back of ankle

Branches of the posterior tibial artery 1- circumflex fibular artery 2-peroneal artery 3- Nutrient artery to the tibia 4- A communicating branch 5 - A malleolar branch 6- calcanean branches 7- muscular branches 8 -Terminal branches : (the medial plantar artery & the lateral plantar artery ) in the sole of the foot

Posterior tibial artery Peroneal artery Muscular branches Muscular branches Medial malleolar Lateral malleolar Medial calcanean Lateral calcanean

Lateral plantar artery Medial plantar artery Lateral plantar artery

Superficial Veins of the lower limb

Patella Saphenous opening Dorsal venous arch Medial malleolus

Great saphenous vein It starts at the medial part of the venous plexus on the dorsum of the foot . It passes upwards in front of the medial malleolus . It joins the femoral vein at the saphenous opening .

Surface anatomy of the great saphenous vein I t ascends infront of the medial malleolus . It continues on the medial side of the leg and knee . At the knee it lies a hand breadth behind the medial border of the patella . It ascends to the thigh deviates forwards and laterally to reach the saphenous opening .

Femoral vein Saphenous opening Great saphenous vein

Tributaries of great saphenous vein 1- The superficial epigastric vein . 2- The superficial circumflex iliac vein. 3-The superficial external pudendal vein .

Tributaries Superficial circumflex iliac v. Superficial External Superficial epigastric v. Superficial circumflex iliac v. Superficial External pudendal v. Superficial medial femoral v. Superficial lateral femoral v. Great saphenous v. Tributaries

Small saphenous vein Origin : on the dorsum of the foot by union of the lateral end of the dorsal venous arch with the lateral dorsal digital vein of the little toe . Course : it passes behind the lateral malleolus and ascends on the back of the leg . Termination : about the middle of the popliteal fossa it pierces the popliteal fascia to end in the popliteal vein . It is joined by number of perforating veins to deep veins of the calf .

Great saphenous vein Small saphenous vein

Normal venous return Valves of deep v Valves of gsv Saphenous opening

Normal and abnormal venous return Valves of perforated vein Valves gsv ------- divides the vein into segments Cont. of ms------ comp. of deep veins chieves 2 things 1----- pump blood upwards to heart 2--- pump blood from superficial vs to deep vs.------ muscle pump Varicose vein

Varicose vein

Deep veins of the lower limb

Popliteal vein +It is one of the content Of the popliteal fossa , it is formed by Union of anterior and posterior Tibial veins at the distal border of the Popliteus muscle . Termination :at the opening into Adductor magnus muscle as femoral vein Popliteal vein

The femoral vein Origin : It is the continuation of the popliteal vein at the opening into adductor magnus muscle. It continues medial to the midinguinal point as the external iliac vein .

Tributaries of the femoral vein