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Arterial & Venous Trees

Major Arteries of The Upper Limb

The blood supply to the upper limb is provided by the


subclavian artery. As the artery enters the axilla by
passing over the lateral border of the first rib, it is
renamed the axillary artery.

The axillary artery is surrounded by the three cords of


the brachial plexus. After passing the lower margin of
Teres Major, it is renamed the brachial artery.

The brachial artery is the main artery of the arm,


travelling in close relation to the median nerve. It gives
of an early branch known as the profunda brachii, which
travels through the posterior compartment of the arm,
accompanying the radial nerve through the spiral
groove of the humerus.

As the artery enters the cubital fossa, it bifurcates into


the radial and ulnar arteries. In some individuals the
bifurcation is located superior to the cubital fossa.

The radial artery travels down the lateral part of the


forearm, giving off a few branches as it does so, before
terminating in the deep palmar arch of the hand.

The ulnar artery travels down the medial side of the


forearm, also giving off a few branches before
terminating in the superficial palmar arch of the hand

A collateral circulation of recurrent and collateral


arteries is established around the elbow joint.
Major Veins From The Upper Limb
Venous return from the forearm and hand is via two
main superficial veins.

The cephalic vein has a superficial course up the


anterolateral side of the arm, travelling through the
deltopectoral groove as it does so. It empties into the
axillary vein after passing through the deltopectoral
triangle. The position of the vein in the deltopectoral
groove is very consistent, making cannulation in this
region much easier.

The basilic vein communicates with the cephalic vein


freely and variably throughout its course, but the
main communicating vessel between them is the
median cubital vein, which provides collateral venous
return in the event of a blockage. The basilic vein is
superficial in the forearm but goes deep about
halfway up the arm before joining with the brachial
veins to form the axillary vein.

Both these veins originate from the dorsal venous


plexus of the hand, which is highly variable and very
superficial.
Major Arteries To The Lower Limb
The aortic bifurcation at L4 gives rise to the
common iliac arteries. Each of these bifurcate
into internal and external iliac arteries. The
internal iliac arteries supply the pelvis, whereas
the external iliac arteries provide the blood
supply to the lower limb.

After giving off the inferior hypogastric and deep


circumflex iliac arteries, the external iliac artery
becomes the femoral artery as it passes into the
femoral triangle. The femoral artery gives off an
early branch - the profunda femoris, which
supplies the deep and posterior structures of
the thigh and terminates before reaching the
knee. The femoral artery proper continues
giving off branches before becoming the
popliteal artery as it exits the adductor canal.

The popliteal artery gives off several genicular


branches to supply the knee joint, the sural
artery to supply the calf muscles and its
terminal branches, the anterior and posterior
tibial arteries.

The anterior tibial artery travels down the


anterior aspect of the leg, giving off recurrent
arteries before crossing over the anterior aspect
of the ankle into the dorsalis pedis artery.

The posterior tibial artery courses down the


posterior aspect of the leg, giving off the fibular
artery early on, and the medial and lateral
plantar arteries when it reaches the foot.

The fibular artery supplies the lateral leg, and


has a communicating branch with the anterior
tibial artery.
Major Veins From The Lower Limb
The venous drainage of the lower limb starts with
venous plexi in the foot, eventually draining into the
plantar and dorsal venous arches and the dorsalis
pedis vein.

The dorsal venous arch gives rise to the lesser


saphenous vein (or short saphenous vein) which
courses around to the lateral aspect of the foot
before running under the lateral malleolus and
ascending up the posterior aspect of the leg in close
association with the sural nerve. It importantly
passes between the heads of Gastrocnemius before
draining into the popliteal vein.

The popliteal vein also arises from the anterior and


posterior tibial veins and has the same course as the
popliteal artery, becoming the femoral vein as it exits
the adductor canal.

The great saphenous vein (or long saphenous vein)


is the longest venous vessel in the body and arises
from the dorsal venous arch of the foot. It courses
around the medial malleolus before ascending all the
way up the medial aspect of almost the entire lower
limb, running over the posterior border of the medial
epicondyle of the femur as it does so. At the top of
the thigh, the great saphenous vein courses medially,
before passing through the saphenous opening in
the fascia lata to drain into the femoral vein at the
saphenofemoral junction in the femoral triangle.

The femoral vein accompanies the femoral artery


through its course, becoming the external iliac vein
as it passes the inferior margin of the inguinal
ligament. The femoral vein has an important
communication with the axillary vein from the upper
limb, known as the thoracoepigastric vein.
Important Structures At The Root Of The Neck

A vast quantity of important structures are present at the root of the neck. The primary branches of
the aortic arch ascend out through the superior thoracic aperture before giving off cutaneous and
muscular branches to the structures in the neck. The brachial plexus formed from spinal nerve roots
C5-T1 form their trunks at the root of the neck before moving into the axilla to form their divisions and
cords. The trunks pass between the anterior and posterior scalene muscles.

The subclavian arteries each provide supply to the anterior thorax via the internal thoracic arteries
which descend parallel to the midline, either side of the sternum. The thyrocervical trunks from them
give rise to the inferior thyroid arteries, ascending and transverse cervical, and suprascapular arteries
which supply the structures of the neck. The vertebral arteries from each subclavian artery ascend
toward the brain through the foramina transversaria of the cervical vertebrae to form part of the
cerebral arterial circle. The subclavian veins returning blood from the upper limbs join the two internal
jugular veins from the head to form the brachiocephalic veins, which unite in the superior
mediastinum to form the superior vena cava. The thoracic duct, the major lymphatic vessel of the
body, loops over the subclavian artery to empty into the subclavian vein.

In addition to the brachial plexus, the middle and inferior cervical ganglia are also present near the
sixth and seventh cervical vertebrae, these give off sympathetic innervation and give rise to the two
sympathetic trunks which descend down the trunk.

The phrenic nerve can be seen weaving past the branches of the right thyrocervical trunk, and the
recurrent laryngeal nerves can be seen poking out just lateral to the common carotid arteries.