VASCULAR APPLIED ANATOMY OF UPPER LIMB
LEARNING OBJECTIVES
•At the end of the lecture the student should be able to
•Revise main arterial supply of upper limb
•Importance of anastomoses in upper limb in relation to injuries
•Injuries or disease associated with vessels of upper limb
ARTERIAL SUPPLY OF UPPER LIMB
•Subclavian artery
•Axillary artery
•Brachial artery
•Radial artery
•Ulnar artery
•Superficial arterial arch
•Deep palmar arch
SUBCLAVIAN ARTERY
•On Right arises from brachiocephalic trunk.
•On Left from arch of aorta.
•Extends from arch of aorta to lateral border
of first rib.
Branches.
-Internal thoracic artery
-Vertebral artery
-Thyrocervical trunk
(a) Suprascapular artery forms anastomosis around scapula
(b) Transverse cervical
(c) Inferior thyroid
AXILLARY ARTERY
Continuation of subclavian artery
from lateral border of first rib to lower border of teres
major muscle
Division ( In to 3 parts) by pectoralis minor
Branches
From 1st part Superior Thyroid artery
From 2nd part 1.Thoracoacromial
2. Lateral thoracic artery
rd
From 3 part 1. Subscapular artery
2. Ant. humeral circumflex
3. Post. humeral circumflex
ANASTOMOSES AROUND SCAPULA
•Between branches of subclavian and axillary artery
•Suprascapular artery of subclavian anastomoses with
circumflex scapular branch of Subscapular( a branch of axillary)
CLINICAL SIGNIFICANCE OF SCAPULAR
ANASTAMOSIS
•Obstruction between 1st part of subclavian and 3rd part of axillary
artery
•Anastomoses provides collateral circulation and prevent ischemia
THORACIC OUTLET SYNDROME
Compression of subclavian artery due to
1. Cervical Rib
2. Abnormal attachment of scalene muscle
3. Fibrous band compression on the artery
THORACIC OUTLET SYNDROME
Clinical findings
•Radial pulse may be absent
•Complete occlusion of artery can result in ischemia & gangrene
of upper limb
• Plethora due to obstruction of superior vena cave
CERVICAL RIB
THROMBOEMBOLISM
•Any thrombus or clot from heart if lodged in the subclavian
vessels of upper limb can result in the ischemia of upper limb
•Complete occlusion of subclavian can also result in ischemia
of upper limb
BRACHIAL ARTERY
•Continuation of axillary artery
•From inferior border of teres major
• bifurcates in cubital fossa into radial
and ulnar artery
Branches
•Profunda brachii
•Superior ulnar collateral artery anastomoses with posterior
ulnar recurrent
•Inferior ulnar collateral
Anastomoses with anterior ulnar recurrent
•Radial
•Ulnar
ANASTOMOSES AROUND ELBOW
Branches from brachial
•Superior and inferior ulnar collateral
Branches from Profunda brachii
•Middle and radial collateral
Branches from ulnar
•Anterior and posterior ulnar recurrent
Branches from radial
•Radial recurrent
Branches from common interosseus
•Interosseus recurrent
INJURIES TO BRACHIAL ARTERY AND IMPORTANCE OF ANASTOMOSES
AROUND ELBOW
•Traumatic injuries
•Thrombosis
•Laceration
•Puncture of brachial artery
If anstomoses around elbow is inadequate, obstruction or injury to brachial
artery may be catastrophic, leading to loss of the forearm and hand
TRAUMATIC INJURY TO BRACHIAL ARTERY
•Both penetrating and blunt trauma
•Associated with humeral fractures in proximal one-third and in distal one-third near the
elbow
•Degree of ischemia depends on whether injury is proximal or distal to Profunda brachii
•Injury to the brachial artery above the Profunda brachii artery --- loss of limb in about
50% of cases
•Injury to brachial below level of Profunda brachii - loss of limb in 25% of cases
THROMBOSIS OF BRACHIAL ARTERY
•Main cause is cardiac catheterization
•1.5% of patients required thrombectomy and local arterial
reconstruction after cardiac catheterization
• The patients may suffer severe ischemia immediately, may be
asymptomatic because of the extensive collateral circulation
about the elbow
POST ACCIDENTAL DAMAGE TO BRACHIAL ARTERY
Surgical repair is recommended even if pt is only mildly symptomatic as chances of
developing subsequent thrombosis in untreated patients are high
PUNCTURE OF BRACHIAL ARTERY
•Can occur while performing arterial tap for arterial blood
gases ABG’s or maintaining intravenous line
•Resulting hematoma compresses the artery in cubital fossa
•May result in ischemia and severe disability
SUPERFICIAL AND DEEP PALMAR ARCH
Superficial
•Direct continuation of ulnar artery
•Completed on the lateral side by superficial palmar branch of
radial
Deep arch
•Direct continuation of radial artery
•Completed on medial side by deep palmar branch of ulnar
ALLEN TEST
•To check patency of palmar arches
•For occlusion of the radial or ulnar artery
•One of these arteries is compressed after blood has been
forced out of the hand by clenching it into a fist
•Failure of change of color of the hand when opened
indicates that the artery not compressed is not patent
•Reduces the risk of ischemia while intervening radial and
ulnar arteries in maintaining intravenous line or doing arterial
tap etc.
SUPERFICIAL VEINS OF UPPER LIMB
Dorsal venous network.
•Receive venous drainage from hand
Cephalic vein
•Lateral continuation of dorsal venous network runs on lateral
side of forearm
• Drains in to axillary veins
Basilic vein
•Medial continuation runs on medial side of forearm
•Pierces the deep fascia of arm joins venae commitants of
brachial artery to form axillary vein.
Medial cubital vein
•Connects cephalic & Basilic veins in front of cubital fossa.
RAYNAUD’S PHENOMENON
•This condition is usually associated with vasculitis and is common in
women
• Results in vasoconstriction in hand especially when exposed to cold
• Causes tingling sensation in hand and bluish discoloration of digits
• Can also result in gangrene of digits in extreme cases
VENOUS DISORDERS
Thrombophelibitis
•Due to I/V cannulation for longer periods
Deep venous thrombosis
•Very uncommon
•Associated with axillary dissection in breast surgery
•Radiotherapy of axilla for breast carcinoma
ARTERIOGRAM SHOWING AXILLARY AND BRACHIAL ARTERY