ARTERIAL SYSTEM

EMBRYOLOGY, HISTOLOGY OF VESSELS

AND COURSE OF SURAL ARTERY
BY DR. SUMITKUMAR BHAGAT
The peripheral vascular system (PVS) includes
all the blood vessels that exist outside the
heart. The peripheral vascular system is
classified as follows:
1. The aorta and its branches:
2. The arterioles
3. The capillaries
4. The venules and
5. veins returning blood to the heart
The function and structure of each segment of
the peripheral vascular system vary depending
on the organ it supplies.
Aside from capillaries, blood vessels are all
made of three layers:
The adventitia or outer layer which provides
structural support and shape to the vessel
The tunica media or a middle layer
composed of elastic and muscular tissue which
regulates the internal diameter of the vessel
The tunica intima or an inner layer consisting
of an endothelial lining which provides a
frictionless pathway for the movement of
blood
Within each layer, the amount of muscle and
collagen fibrils varies, depending on the size
and location of the vessel.
Arteries
Arteries play a major role in nourishing organs
with blood and nutrients. Arteries are always
under high pressure. To accommodate this
stress, they have an abundance of elastic tissue
and less smooth muscle. The presence of
elastin in the large blood vessels enables these
vessels to increase in size and alter their
diameter. When an artery reaches a particular
organ, it undergoes a further division into
smaller vessels that have more smooth muscle
and less elastic tissue. As the diameter of the
blood vessels decreases, the velocity of blood
flow also diminishes. Estimates are that about
10% to 15% of the total blood volume is
contained in the arterial system. This feature of
high systemic pressure and low volume is
typical of the arterial system.
There are two main types of arteries found in
the body: (1) the elastic arteries, and (2) the
muscular arteries. Muscular arteries include
the anatomically named arteries like the
brachial artery, the radial artery, and the
femoral artery, for example. Muscular arteries
contain more smooth muscle cells in the tunica
media layer than the elastic arteries. Elastic
arteries are those nearest the heart (aorta
and pulmonary arteries) that contain much
more elastic tissue in the tunica media than
muscular arteries. This feature of the elastic
arteries allows them to maintain a relatively
constant pressure gradient despite the
constant pumping action of the heart
Arterioles
Arterioles provide blood to the organs and are
chiefly composed of smooth muscle. The
autonomic nervous system influences the
diameter and shape of arterioles. They
respond to the tissue's need for more
nutrients/oxygen. Arterioles play a significant
role in the systemic vascular resistance
because of the lack of significant elastic tissue
in the walls.
The arterioles vary from 8 to 60 micrometers.
The arterioles further subdivide into meta-
arterioles.
Capillaries
Capillaries are thin-walled vessels composed of
a single endothelial layer. Because of the thin
walls of the capillary, the exchange of nutrients
and metabolites occurs primarily via diffusion.
The arteriolar lumen regulates the flow of
blood through the capillaries.
Venules
Venules are the smallest veins and receive
blood from capillaries. They also play a role in
the exchange of oxygen and nutrients for water
products. There are post-capillary sphincters
located between the capillaries and venules.
The venule is very thin-walled and easily prone
to rupture with excessive volume.
Veins
Blood flows from venules into larger veins. Just
like the arterial system, three layers make up
the vein walls. But unlike the arteries, the
venous pressure is low. Veins are thin-walled
and are less elastic. This feature permits the
veins to hold a very high percentage of the
blood in circulation. The venous system can
accommodate a large volume of blood at
relatively low pressures, a feature termed high
capacitance. At any point in time, nearly three-
fourths of the circulating blood volume is
contained in the venous system. One can also
find one-way valves inside veins that allow for
blood flow, toward the heart, in a forward
direction. Muscle contractions aid the blood
flow in the leg veins. The forward blood flow
from the lower extremities to the heart is also
influenced by respiratory changes that affect
pressure gradients in the abdomen and chest
cavity.
Structure and Function
Vessels transport nutrients to organs/tissues
and to transport wastes away from
organs/tissues in the blood. A primary purpose
and significant role of the vasculature is its
participation in oxygenating the
body. Deoxygenated blood from the peripheral
veins is transported back to the heart from
capillaries, to venules, to veins, to the right
side of the heart, and then to the lungs.
Oxygenated blood from the lungs is
transported to the left side of the heart into
the aorta, then to arteries, arterioles, and
finally capillaries where the exchange of
nutrients occurs. Loading and unloading of
oxygen and nutrients occur mostly in the
capillaries.
EMBRYOLOGY
Blood vessels arise from the mesodermal
embryonic layer. Embryonic development of
vessels and the heart begins in the middle of
the third week of life. Fetal circulation through
this vasculature system begins around the
eighth week of development.
Blood vessel formation occurs via two main
mechanisms: (1) vasculogenesis and (2)
angiogenesis.
1. Vasculogenesis is the process by which
blood vessels form in the embryo. Interactions
between precursor cells and various growth
factors derive the cellular differentiation seen
with vasculogenesis. Such as Bone
morphogenetic protein (BMP), Notch (receptor
affine to integrin proteins) and Gata
(transcription factors) families, T-box (a group
of transcription factors); myocardin,
semaphorin family are protein molecules
capable of inducing a correct embryological
development of the aortic arch.
Hoxa3 is a protein-coding gene involved in the
regulation of the third pharyngeal arch, which
molecule comes from the neural crests. This
molecule conditions the physiological
development of the carotid artery system.
Precursor mesodermal cells and their receptors
respond to FGF2 to
become hemangioblasts. Hemangioblast recep
tors then respond to VEGF, inducing further
differentiation into endothelial cells. These
endothelial cells then coalesce, forming the
first hollow blood vessels. The first blood
vessels formed by vasculogenesis include the
dorsal aorta and the cardinal veins.
All other vasculature in the human body forms
by angiogenesis..
2. Angiogenesis is the process in which new
blood vessels derive from the endothelial layer
of a pre-existing vessel. Interactions involving
VEGF drive angiogenesis. This process is the
predominant form of neovascularization in the
adult
Blood Supply and Lymphatics

• The walls of large blood vessels, like the

aorta and the vena cava, are supplied
with blood by vasa vasorum. This term
translates to mean "vessel of a vessel."
• Three types of vasa vasorum exist (1)
vasa vasorum internae, (2) vasa vasorum
externae, and (3) venous vasa vasorae.
1. Vasa vasorum internae originate from the
lumen of a vessel and penetrate the
vessel wall to supply oxygen and
nutrients.
2. Vasa vasorum externae originate from a
nearby branching vessel and feedback
into the larger vessel wall.
3. Venous vasa vasorae originate within the
vessel wall and drain into a nearby vein
to provide venous drainage for vessel
walls.
Nerves
The sympathetic nervous system primarily
innervates blood vessels. The smooth muscles
of vasculature contain alpha-1, alpha-2, and
beta-2 receptors. A delicate balance between
the influence of the sympathetic and
parasympathetic nervous systems is
responsible for the underlying physiological
vascular tone. Specialized receptors located in
the aortic arch and the carotid arteries acquire
information regarding blood pressure
(baroreceptors) and oxygen content
(chemoreceptors) from passing blood. This
information is then relayed to the nucleus of
the solitary tract via the vagus nerve. Blood
vessel constriction or relaxation then ensues
accordingly, determined by the body's
sympathetic response.
 HISTOLOGY
• Muscles
. • Blood vessels contain only
smooth muscle cells. These
muscle cells reside within the
tunica media along with
elastic fibers and connective
tissue. Although vessels only
contain smooth muscles, the
contraction of skeletal muscle
plays an important role in the
movement of blood from the
periphery towards the heart
through the venous system
SURAL ARTERY
• What is the sural artery?
• The sural arteries
are branches from the
popliteal artery in each
popliteal fossa. They arise
inferiorly to the inferior
geniculate arteries and
pass distally through the
deep fascia to supply the
superior parts of the calf
muscles.
• The sural arteries (inferior muscular
arteries) are two large branches, lateral
and medial, which are distributed to the
gastrocnemius, soleus, and plantaris
muscles.
• Sural means related to the calf.
• The term applies to any of four or five
arteries arising from the popliteal artery,
with distribution to the muscles and
integument of the calf, and with
anastomoses to the posterior tibial,
medial and lateral inferior genicular
arteries.
• Sural artery pierces deeply into the
muscle through the muscular center and
ends at the Achilles tendon. It gave off
several sural artery-perforating branches
to supply blood for the covering skin.
 COARSE OF SURAL ARTERY
1. Each head of gastrocnemious muscle supplied by sural artery,
which arises from popliteal artery above the level of knee joint
line, descends 2-5 cm and enters thedeep surface muscle along
the inter-fascicular hilum at the tibial tuberosity.
2. Artery has 2-3 main branches, which supply the gastrocnemious
individual heads.
3. Each artery accompanies 2 vene comitantes.
4. Medial branch enters directly into muscle, whereas lateral hasto
cross popliteal vein and tibial nerve and gives off branches to
plantaris.
5. Lateral sural artery runs over the surface of muscle and gives of
superficial cutaneous branches
Medial and lateral sural artery

1. These are short coursed arteries. Medial

is dominat than lateral as medial head of
gastrocnemius is well developed
embryonically.
2. They may be dominant supply arteries
when the median artery is absent or arises
from one the these vessels.
3. They give off superficial branches which
supply the overlying skin of posterior leg.
 MEDIAN SURAL ARTERY
• Arises from the POPLITEAL (90%)
• The artery arises at the level of tibial condyles,
runs between the 2 heads and as it descends
2-3cm downwards, it runs in the midline of leg
beneath th deep fascia
• Accompanied by Median cutaneous sural
nerve
• The artery descends down in the muscle
groove to reach the Achilles tendon . Rarely it
goes beyond this point.
 Medial sural perforators:
• The anatomy of the perforators of this artery
are highly variable, encountered at about 4–
5 cm from the midline and 7–10 cm distal to
the popliteal crease.
• The diameter of the medial sural artery is 1–
2 mm .
• The artery is usually accompanied by two
veins (venae comitantes).