1. Angiography Anatomy

2. Circulatory System Comprised of two major divisions
Cardiovascular: includes the heart, blood and vessels
Transportation of oxygen, nutrients, hormones and chemicals necessary for normal body activity.
Removal of waste products through the kidneys and lungs
Maintenance of body temperature and water and electrolyte balance.
To prevent hemorrhage by forming blood clots
Lymphatic system: includes lymph vessels, lymph nodes and lymph glands
Protect against disease
Returns proteins to the blood
Transfers fat

3. Cardiovascular Circulation

5. Cardiovascular Circulation
Simplified version of the cardiovascular circulation
Begins with the heart
Oxygenated blood is pumped from the left atria and ventricle into the aorta and arteries of the body
Arteries supply blood to body parts and organ systems through arteriole and then capillaries.
Deoxygenated blood is then returned through venules and eventually veins
Veins converge into the superior and inferior venae cavae, which will bring the deoxygenated blood to the right atria and ventricle.

6. Blood components
Red Blood Cells are Erythrocytes and are produced in the cancellous or spongy bone (red marrow) of certain bones (sternum, ribs, vertebrae, and pelvis)
It’s function is to transport oxygen by protein hemoglobin to body tissues
White Blood Cells are Leukocytes and are produced in the medullary cavity of some bones (yellow bone marrow) and lymph system.
It’s job is to protect against infection and disease
Platelets originate from bone marrow
They repair tears in blood vessel wall and promote blood clotting.
Platelets are irregularly shaped colorless bodies that are present in blood. Their sticky surface lets them, along with other substances, form clots to stop bleeding.

8. Pulmonary Circulation
Pulmonary circulation is the blood vessels circuit, which supplies blood to the lungs and then is returned to the heart.
The pulmonary arteries carry the deoxygenated blood from the right ventricle of the heart to the lungs
The four pulmonary veins carry the oxygenated blood from the lungs to the left atrium of the heart.

9. Pulmonary Circulation

10. Heart is a muscular organ that pumps blood to all areas of the body.
Lies within the mediastinum; resting on the diaphragm
Myocardium – refers to the cardiac tissue and the heart’s muscular wall. It contracts to pump blood out of the heart, then relaxes as the heart refills with returning blood. The outer surface is called the epicardium and it’s inner lining is the endocardium.

11. Heart Circulation

12. Interesting facts about the heart
It is about the size of your fist
It generally only pumps about 50% of the blood which is in the chamber at the beginning of its pumping phase (this is called the ejection fraction)
It generally pumps about 5 quarts of blood a minute.
It can pump up to about 5 gallons a minute with exercise
It pumps about 4000 gallons of blood each day.

13. General Systemic Circulation – Heart
Superior & Inferior Venae Cavae
Right Atrium
Tricuspid valve- valves are made to prevent substances from re-entering the previous area
Right ventricle: a thin walled chamber that function is to pump blood into the pulmonary system.
Semilunar or pulmonary value – marks the beginning of the artery system - Pulmonary system
Pulmonary artery or pulmonary trunk is the main artery taking deoxygenated blood to the lungs
Blood goes to the right and left lungs where capillaries are in close contact the thin-walled alveoli so that blood can release CO2 and pick up O2.
From the lungs, the pulmonary vein carries oxygenated blood back into the heart via the left atrium.
Left atrium receives oxygenated blood from the lungs
Mitral valve or Bicuspid
Blood enters the left ventricle, which is made of thickened walls; the left ventricle must pump blood throughout the whole body.
Finally blood exits the left semilunar or aortic valve and enters the arch of the aorta to the aorta.
The first arteries to branch off the aorta are the coronary arteries, which supplies oxygenated blood to the heart muscle.

14. Coronary Arteries
The coronary artery goes around the heart like a crown. It’s main function is to deliver oxygenated blood to the heart muscle.
Coronary arteries originate at the aortic bulb
Right coronary artery (RCA) provides blood for the majority of the right atrium, right ventricle and sinoatrial node (cluster of cells in the right atrial wall that regulates the heart’s rhythmic rate. (Divides into the right posterior descending artery and a large marginal branch)
Left coronary artery (LCA) supplies blood to both ventricles and the left atrium of the heart. (Divides into the left anterior descending and circumflex branch)
Additional arteries branch off the two main coronary arteries to supply the heart muscle with blood.
Circumflex artery (Cx) – branches off the left coronary artery and encircles the heart muscle. This artery supplies blood to the back of the heart.
Left anterior descending artery (LAD) – branches off the left coronary artery and supplies blood to the front of the heart.
Smaller branches of the coronary arteries include: acute marginal, posterior descending (PDA), obtuse marginal (OM), and diagonals

16. Coronary Veins
The coronary sinus system returns venous blood to the right atrium of the heart at the lateral border through the triangle of Koch. Triangle of Koch is the area around the atrioventricular node which regulates heart rate.
The coronary sinus is a large vein on the posterior side of the heart between the atria and ventricles. It drains most of the blood from the heart tissue.
Branches of the coronary sinus
Great cardiac vein – receives blood from both ventricles and left atrium
Oblique vein (of Marshall) of the left atrium (posterior aspect)
Obtuse marginal vein
Middle cardiac vein – drains blood from the right ventricle and atrium and part of the left ventricle.
Small cardiac vein – returns blood from the right ventricle. (theses are also termed thebesian veins. Thebesian veins are small venous tributaries that drain directly into the cardiac chambers. They exist primarily in the right atrium and right ventricle.

17. Coronary Veins
Posterior view

19. Cerebral Arteries - Blood Supply to Brain
The brain is supplied by four major arteries:
Right and left common carotid arteries which provide blood to the anterior circulation of the brain
Right and left vertebral arteries which supply blood for the posterior circulation of the brain
A “four-vessel angiogram” would be a radiographic examination of all four vessels supplying the brain and the brain circulation
A “three-vessel angiogram” would be a selective injection of the two carotids and only one vertebral artery.

20. Blood Supply to Brain

21. Aortic Arch Three major branches arise from the arch of the aorta
The brachiocephalic artery (previously called Innominate artery) is a short vessel that will bifurcate into the right common carotid (which further divides into the right internal and external carotids) and the right subclavian artery from which the right vertebral artery will arise.
The left common carotid arises directly from the aortic arch and is slightly longer than the right common carotid.
The left subclavian artery also arises from the aortic arch. The left vertebral will originate from the left subclavian artery.

22. Three Branches of Aortic Arch

24. Carotis Communis- common carotid
The common carotid arteries differ in length and in their mode of origin.
The right common carotid begins at the bifurcation of the brachiocephalic behind the right sternoclavicular joint. It extends until it divides into the external and internal carotids. (around the level of C4.)
Internal carotid (supply blood to the cerebral hemispheres, pituitary gland, orbital structure, external nose and anterior portion of the brain.
External carotid (supply blood to the anterior neck, face, greater part of the scalp and meninges)

26. Common carotid
The left common carotid springs from the highest part of the arch of the aorta to the left of and on a plane posterior to the innominate artery and consists of both a thoracic and a cervical portion.
Thoracic portion ascends from the arch of the aorta and through the superior mediastinum to the level of the left sternoclavicular joint.
Cervical portion begins at the left sternoclavicular joint and ascends to divide into the left internal and left external carotids.
The vertebral arteries pass through the transverse foramina from C6 - C1. From here they pass through the foramen magnum before uniting to form the basilar artery. (the basilar artery rests on the clivus portion of the occipital bone)

27. Neck and Head Arteries
Identify vessels A, B, and C on this right common carotid arteriogram.
Right side

28. Internal Carotid Angiogram (visualizes both anterior and middle cerebral arteries)

29. Vertebrobasilar Arteries

30. Circle of Willis
The internal carotid branches and the basilar arteries join through this circle configuration termed the circle of Willis (arterial circle).
It is an elaborate anastomosis (A natural joining of parts or branches of tubular structures so as to make or become continuous) interconnecting the entire arterial supply of the brain.
It has five branches:
Anterior communicating arteries
Anterior cerebral arteries
Internal carotid arteries
Posterior communicating arteries
Posterior cerebral arteries
The hypophysis or pituitary gland is located within the circle of Willis.
The middle cerebral artery continues as an extension of the internal carotid .
Note the basilar artery and the vertebral arteries relationship to the circle of Willis.

31. Arterial Circle (Circle of Willis)

32. Cerebral Veins – Great Veins of the Neck
Three major veins that drain blood from the head, face and neck
Internal Jugular veins – drain blood from the cranial and orbital cavities. They travel all the way down the neck until they join the subclavian vein.
Vertebral veins – form outside of the cranium and drain the upper neck and occipital regions. Each vertebral vein enters the transverse foramen of C1, descends to C6 and enters the subclavian vein.
The smaller external jugular veins are more superficial vessels that drain the scalp and much of the face and neck. They also travel down the neck and unite with the subclavian vein.
Note: the internal and external jugular, vertebral and subclavian veins join to form the brachiocephalic veins.

33. Great Veins of the Neck

34. Thoracic Aorta The thoracic aorta is subdivided into four segments
Aortic bulb – proximal end of the aorta where it exits the heart and is the area from which the coronary arteries originate.
Ascending aorta – second portion of the aorta and terminates at the second sternocostal joint
Aortic arch – has three arterial branches arising from it (brachiocephalic, left common carotid and left subclavian)
Descending aorta – continuation of the aorta running to the left of the thoracic spine down into the abdomen as the abdominal aorta.

35. Aortic Arch Variations
Most common variations
Left circumflex – arch is normal but the descending aorta is projected downward and to the left.
Inverse aorta – arch is projected to the right instead of to the left.
Pseudocoarctation – descending aorta is arched

36. Variations of Arch
Left circumflex
Inverse aorta
Pseudocoarctation

38. Thoracic Veins Superior Vena Cava Azygos
Superior and Inferior Pulmonary Veins
Pulmonary Arteries

39. Thoracic Veins cont.
Four larger pulmonary veins from the lung – pulmonary veins are the only veins that carry oxygenated blood
Superior vena cava – formed from the uniting of the Left and right brachiocephalic veins
Azygos vein (terminate at the superior vena cava posteriorly) and intercostal veins ( spinal column)

40. Abdominal Aorta Branches
Five major branches from the abdominal aorta
Celiac axis – supplies blood to the liver, spleen, and stomach
Superior mesenteric artery – supplies blood to the pancreas, most of the small intestine, and portions of the large intestine (cecum, ascending, ½ of the transverse)
Left and right renal arteries – supply the kidneys for filtering.
Inferior mesenteric artery – supplies blood to ½ of the transverse colon, descending colon, sigmoid and most of the rectum.

41. Branches of Abdominal Aorta

42. Abdominal aorta anatomy
1. Abdominal Aorta 2. Splenic Artery 3. Celiac Artery 4. Hepatic Artery 5. Renal Artery 6. Intestinal Branches from the Superior Mesenteric Artery 7. Branches from the Inferior Mesenteric Artery 8. Iliac Artery

43. Common iliac Arteries and branches
The abdominal aorta bifurcates at the level of L4 to form the right and left common iliac arteries.
The common iliac’s split to form:
The internal iliac – supply blood to the pelvic organs (urinary bladder, part of the rectum, reproductive organs, and pelvic muscles)
The external iliac – supply blood to the lower limbs

44. Abdominal Veins Below the diaphragm all blood is returned to the right
atrium through the inferior vena cava.
Important parts of the inferior vena cava include:
Internal/ external and common iliac veins - return blood from the lower limbs and pelvic area
Superior/ inferior mesenteric veins - return blood from small intestine, portal and hepatic area, and large intestine. One of the large veins of this area is the portal venous system.
Renal veins - return filtered blood from the kidneys to the heart.

45. Abdominal Veins

47. Iliac/ femoral angiography

48. Portal System Function is to bring venous blood from the digestive
tract, spleen, pancreas and gallbladder to the liver.
The liver filters this blood before returning it to the inferior vena cava.
The large portal vein is the major vessel that carries the unfiltered blood to the liver.
The union of the superior mesenteric and splenic veins forms the portal vein. In most cases the inferior mesenteric vein will terminate in the splenic vein and is not considered a major branch of the portal vein
Once the liver filters blood, it drains into the hepatic veins and passes into the inferior vena cava

49. Hepatic Portal System
Returns venous blood to liver

51. Upper Limb Arteries

52. Upper Limb Veins Two brachials Radial Ulnar Palmar arch
Superficial veins
Cephalic
Basilic
Median cubital
Deep veins
Two brachials
Radial
Ulnar
Palmar arch

53. Lower Limb Arteries

54. Lower Limb Veins Superficial veins Great (long) saphenous
Small (short) saphenous
Dorsalis pedis
Deep veins
Posterior tibial
Anterior tibial
Popliteal
Deep femoral

55. Lymph Drainage
Drains interstitial fluid to venous system

56. Lymphatic System Functions: Fights disease
Returns proteins to the blood
Filters lymph
Transfers fats to the blood
Lymphography vs. lymphangiography