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Arteries

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Dr Badri Paudel www.badripaudel.com

Characteristics of blood vessels

Arteries and arterioles carry blood away from heart Capillaries- site of exchange Venules, veins- return blood to heart

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Endothelium- prevents platelet aggregation secretes substances that control diameter

of blood vessel Tunica media- smooth muscle and connective tissue. Innervated by sympathetic nerves (vasoconstriction) Missing in smallest arteries

Tunica externa- connective tissue; is vascularized

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Capillaries most permeable (and more permeable in some parts than others) Especially so in liver, spleen and red marrow (so cells can enter and leave circulation) Blood flow can vary to different parts of the body, too

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What does this mean?

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Blood is forced through arteries and arterioles vessel walls are too thick for blood components to pass through In capillaries, oxygen and nutrients move out by diffusion; CO2 in (via lipid membrane, channels, etc.) Blood pressure moves molecules out by filtration Plasma proteins maintain osmotic pressure of blood 5/1/12 8

Returning blood to the heart Venules are continuous with capillaries; take in some returned fluid (rest is retained by tissues or returned to blood via lymphatic System) Veins have thinner walls; less muscle; but can hold much more blood

Many veins in limbs have valves to prevent Backflow (Varicose veins arise when pressure on valves is prolonged) 5/1/12 9 5/1/12 10

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Major arteries and veins of the systemic circuit

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The branches of the arch of aorta can be remembered as ABCS:

n  A = Arch of Aorta n  B = Brachiocephalic artery n  C = Left common carotid artery n  S = Left subclavian artery

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Aor$c  Arch  

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Aor$c  Arch  5/1/12   17  

External  caro$d  Artery  

ECA  a8er  origin  from  the  common  caro$d  artery  takes  a  slightly  curved  course  upwards  and  anteriorly  before  inclining  backwards  to  the  space  behind  the  neck  of  the  mandible.  

Within  the  paro$d  gland,  it  branches  terminally  into  the  superficial  temporal  and  maxillary  arteries.  Along  its  course,  it  rapidly  diminishes  in  size  and  as  it  does  so,  gives  of  various  branches.    

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Some  Angry  Lady  Figured  Out  PMS  

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Ext.  caro$d  a  5/1/12   21   5/1/12   22  

Clinical  aspects  of  External  Caro1d  Artery  (ECA)  

1.  The  2  main  vessels  supplying  the  meninges  are  the  meningeal  branches  of  the  occipital  and  maxillary  arteries.  Vasodila1on  of  these  vessels  creates  excessive  pressure  on  the  sensory  receptors  within  the  meninges,  resul1ng  in  a  headache.  

2.  Superficial  temporal  artery  is  palpable  on  the  zygoma1c  process.  

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3.  Middle  meningeal  artery  which  is  the  branch  of  Maxillary  artery  ascends  through  the  foramen  spinosum  and  helps  to  supply  the  meninges.  Its  prac1cal  importance  is  that  it  may  be  torn  in  a  skull  fracture  and  result  in  the  forma1on  of  an  extradural  haematoma.  

4.  External  caro1d  artery  stenosis  may  follow  caro1d  endarterectomy  

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Aorta    

•  The  thoracic  aorta  is  contained  in  the  posterior  medias/nal  cavity.  

•  It  begins  at  the  lower  border  of  the  fourth  thoracic  vertebra  where  it  is  con/nuous  with  the  aor/c  arch,  and  ends  in  front  of  the  lower  border  of  the  twel;h  thoracic  vertebra,  at  the  aor/c  hiatus  in  the  diaphragm  where  it  becomes  the  abdominal  aorta.  

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Branches  of  Abd  Aorta  

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Abdominal  Aorta    

Celiac  Artery  •  Le;  Gastric  Artery  -­‐  Supplies  blood  to  the  esophagus  and  por/ons  of  the  stomach.  

•  Hepa/c  Artery  -­‐  Supplies  blood  to  the  liver.  •  Splenic  Artery  -­‐  Supplies  blood  to  the  stomach,  spleen,  and  pancreas.  

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•  Superior  Mesenteric  Artery  -­‐  Supplies  blood  to  the  intes/nes.  

•  Inferior  Mesenteric  Artery  -­‐  Supplies  blood  to  the  colon.  

•  Renal  Arteries  -­‐  Supplies  blood  to  the  kidneys.  •  Ovarian  Arteries  -­‐  Supplies  blood  to  the  female  reproduc/ve  organs.  

•  Tes/cular  Arteries  -­‐  Supplies  blood  to  the  male  reproduc/ve  organs.  5/1/12   28  

Internal  Iliac  Artery  •  The  internal  iliac  artery  (formerly  known  as  the  hypogastric  artery)  is  the  main  artery  of  the  pelvis.    

•  It  is  a  short,  thick  vessel,  smaller  than  the  external  iliac  artery,  and  about  3  to  4  cm  in  length.  

•  The  internal  iliac  artery  supplies  the  walls  and  viscera  of  the  pelvis,  the  buWock,  the  reproduc$ve  organs,  and  the  medial  compartment  of  the  thigh.  

•  The  vesicular  branches  of  the  internal  iliac  arteries  supply  the  bladder.    

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Branches  

     iliolumbar  artery,  lateral  sacral  artery,  superior  gluteal  artery,  inferior  gluteal  artery,  middle  rectal  artery,  uterine  artery,  obturator  artery,  inferior  vesical  artery,  superior  vesical  artery,  obliterated  umbilical  artery,  internal  pudendal  artery    

 

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Femoral  Artery  

•  The  artery  which  supplies  the  greater  part  of  the  lower  extremity  is  the  direct  con$nua$on  of  the  external  iliac.    

•  It  runs  as  a  single  trunk  from  the  inguinal  ligament  to  the  lower  border  of  the  Popliteus,  where  it  divides  into  two  branches  

•  the  anterior  and  posterior  /bial.  The  upper  part  of  the  main  trunk  is  named  the  femoral,  the  lower  part  the  popliteal.    

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Branches.—The  branches  of  the  femoral  artery  are:          

Superficial  Epigastric;  Deep  External  Pudendal,  Superficial  Iliac  Circumflex,    Muscular  Superficial  External  Pudendal,  Profunda  Femoris.      

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The  branches  of  the  femoral  artery  

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As  the  Common  femoral  artery  (CFA)  can  o8en  be  palpated  through  the  skin,  it  is  o8en  used  as  a  catheter  access  artery  

The  CFA  is  suscep$ble  to  peripheral  arterial  disease.    When  a  CFA  is  blocked  through  atherosclerosis,  percutaneous  interven$on  with  access  from  the  opposite  CFA  may  be  needed.  

The  common  femoral  artery  can  be  used  to  draw  arterial  blood.  Presence  of  a  femoral  pulse  has  been  es2mated  to  indicate  a  systolic  blood  pressure  of  more  than  50  mmHg,  as  given  by  the  50%  percen2le.  5/1/12   34  

Popliteal  Artery  

•  In  human  anatomy,  the  popliteal  artery  is  defined  as  the  extension  of  the  "superficial"  femoral  artery  a;er  passing  through  the  adductor  canal  and  adductor  hiatus  above  the  knee.    

•  The  termina/on  of  the  popliteal  artery  is  its  bifurca/on  into  the  anterior  /bial  artery  and  posterior  /bial  artery.  

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•  The  branches  of  the  popliteal  artery  are:  anterior  $bial  artery,  posterior  $bial  artery,  sural  artery,medial  superior  genicular  artery,  lateral  superior  genicular  artery,  middle  genicular  arterylateral  inferior  genicular  artery,  medial  inferior  genicular  artery  

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Posterior  $bial  artery  

•  The  posterior  /bial  artery  of  the  lower  limb  carries  blood  to  the  posterior  compartment  of  the  leg  and  plantar  surface  of  the  foot,  from  the  popliteal  artery.  It  is  accompanied  by  a  deep  vein,  the  posterior  /bial  vein,  along  its  course.  

•  It  typically  gives  rise  to  the  fibular  artery.It  also  gives  rise  to  medial  plantar  artery  and  lateral  plantar  artery.In  addi$on  a  calcaneal  branch  to  the  medial  aspect  of  the  calcaneus.  5/1/12   38  

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•  The  posterior  $bial  artery  pulse  can  be  readily  palpated  posterior  and  inferior  to  the  medial  malleolus  and  is  o8en  examined  by  physicians  when  assessing  a  pa$ent  for  peripheral  vascular  disease.    

•  It  is  very  rarely  absent  in  young  and  healthy  individuals;  in  a  study  of  547  healthy  individuals  only  one  person  did  not  have  a  palpable  posterior  $bial  artery.    

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Anterior  $bial  Artery  

•  The  anterior  /bial  artery  of  the  lower  limb  carries  blood  to  the  anterior  compartment  of  the  leg  and  dorsal  surface  of  the  foot,  from  the  popliteal  artery.  

•  It  is  accompanied  by  a  deep  vein,  the  anterior  /bial  vein,  along  its  course.  

•  It  crosses  the  anterior  aspect  of  the  ankle  joint,  at  which  point  it  becomes  the  dorsalis  pedis  artery.  

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dorsalis  pedis  artery  

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Axillary  artery  

•  In  human  anatomy,  the  axillary  artery  is  a  large  blood  vessel  that  conveys  oxygenated  blood  to  the  lateral  aspect  of  the  thorax,  the  axilla  (armpit)  and  the  upper  limb.    

•  Its  origin  is  at  the  lateral  margin  of  the  first  rib,  before  which  it  is  called  the  subclavian  artery.    

•  A;er  passing  the  lower  margin  of  teres  major  it  becomes  the  brachial  artery.  

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"She  Tastes  Like  Sweet  Apple  Pie."  

First  part  (1  branch):  Superior  thoracic  artery  (Supreme  thoracic  artery)  

Second  part  (2  branches):  Thoraco-­‐acromial  artery,  Lateral  thoracic  artery.    

Third  part  (3  branches):  Subscapular  artery,  Anterior  humeral  circumflex  artery,  Posterior  humeral  circumflex  artery  

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Brachial  artery  

•  It  con$nues  down  the  ventral  surface  of  the  arm  un$l  it  reaches  the  cubital  fossa  at  the  elbow.  It  then  divides  into  the  radial  and  ulnar  arteries  which  run  down  the  forearm.    

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Radial  and  ulnar  artery  

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Radial  Artery  

•  The  artery's  pulse  is  palpable  in  the  anatomical  snuff  box  and  on  the  anterior  aspect  of  the  arm  over  the  carpal  bones  

•  Presence  of  radial  pulse  has  been  es2mated  to  indicate  a  systolic  blood  pressure  of  more  than  70  mmHg  

•  The  radial  artery  is  used  for  coronary  artery  bypass  gra@ing  and  is  growing  in  popularity  among  cardiac  surgeons.  

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Dural  venous  sinuses    

•  The  dural  venous  sinuses  (also  called  dural  sinuses,  cerebral  sinuses,  or  cranial  sinuses)  are  venous  channels  found  between  layers  of  dura  mater  in  the  brain.  

•   They  receive  blood  from  internal  and  external  veins  of  the  brain,  receive  cerebrospinal  fluid  (CSF)  from  the  subarachnoid  space,  and  ul/mately  empty  into  the  internal  jugular  vein.  

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dural  venous  sinuses    •  The  walls  of  the  dural  venous  sinuses  are  composed  of  dura  mater  lined  with  endothelium,  a  specialized  layer  of  flaWened  cells  found  in  blood  vessels.    

•  They  differ  from  other  blood  vessels  in  that  they  lack  a  full  set  of  vessel  layers  (e.g.  tunica  media)  characteris$c  of  arteries  and  veins.  It  also  lacks  valves  as  seen  in  veins.    

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Clinical  relevance    

•  The  sinuses  can  be  injured  by  trauma.  Damage  to  the  dura  mater,  which  may  be  caused  by  skull  fracture,  may  result  in  blood  clot  forma$on  (thrombosis)  within  the  dural  sinuses.    

•  While  rare,  dural  sinus  thrombosis  may  lead  to  hemorrhagic  infarc$on  with  serious  consequences  including  epilepsy,  neurological  deficits,  or  death.    

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Superior  venacava    

The  superior  vena  cava  (also  known  as  the  precava  or  SVC)  is  truly  superior,  a  large  diameter,  yet  short,  vein  that  carries  deoxygenated  blood  from  the  upper  half  of  the  body  to  the  heart's  right  atrium.  

It  is  formed  by  the  le;  and  right  brachiocephalic  veins,  (also  referred  to  as  the  innominate  veins)  which  also  receive  blood  from  the  upper  limbs,  head  and  neck,  behind  the  lower  border  of  the  first  right  costal  car/lage.    5/1/12   59  

•  The  azygos  vein  (which  receives  blood  from  the  rib  cage)  joins  it  just  before  it  enters  the  right  atrium,  at  the  upper  right  front  por/on  of  the  heart.  It  is  also  known  as  the  cranial  vena  cava  in  animals.  

•  No  valve  separates  the  superior  vena  cava  from  the  right  atrium.  As  a  result,  the  (right)  atrial  and  (right)  ventricular  contrac/ons  are  conducted  up  into  the  internal  jugular  vein  and,  through  the  sternocleidomastoid  muscle,  can  be  seen  as  the  jugular  venous  pressure.  In  tricuspid  valve  regurgita/on,  these  pulsa/ons  are  very  strong.  5/1/12   60  

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Superior  vena  cava  syndrome  (SVCS)  

•  is  usually  the  result  of  the  direct  obstruc/on  of  the  superior  vena  cava  by  malignancies  such  as  compression  of  the  vessel  wall  by  right  upper  lobe  tumors  or  thymoma  and/or  medias/nal  lymphadenopathy.    

•  The  most  common  malignancies  that  cause  SVCS  is  bronchogenic  carcinoma.  Cerebral  edema  is  rare,  but  if  it  occurs  it  may  be  fatal  

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Bronchogenic  carcinoma-­‐SVC  Obstruc$on  

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Inferior  Vena  Cava  

•  is  the  large  vein  that  carries  de-­‐oxygenated  blood  from  the  lower  half  of  the  body  into  the  right  atrium  of  the  heart.  

•  It  is  posterior  to  the  abdominal  cavity  and  runs  alongside  of  the  vertebral  column  on  its  right  side  (i.e.  it  is  a  retroperitoneal  structure).    

•  It  enters  the  right  atrium  at  the  lower  right,  back  side  of  the  heart.  

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•  Health  problems  aWributed  to  the  IVC  are  most  o8en  associated  with  it  being  compressed  (ruptures  are  rare  because  it  has  a  low  intraluminal  pressure).    

•  Typical  sources  of  external  pressure  are  an  abdominal  aor$c  aneurysm,  the  gravid  uterus  and  abdominal  maligancies,  such  as  colorectal  cancer,  renal  cell  carcinoma  and  ovarian  cancer.    

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•  Since  the  inferior  vena  cava  is  primarily  a  right-­‐sided  structure,  unconscious  pregnant  females  should  be  turned  on  to  their  le8  side  (the  recovery  posi$on),  to  relieve  pressure  on  it  and  facilitate  venous  return.    

•  In  rare  cases,  straining  associated  with  defeca$on  can  lead  to  restricted  blood  flow  through  the  IVC  and  result  in  syncope  (fain$ng).  

•  Occlusion  of  the  IVC  is  rare,  but  considered  life-­‐threatening  and  is  an  emergency.  It  is  associated  with  deep  vein  thrombosis,  IVC  filters,  liver  transplanta$on  and  instrumenta$on  (e.g.  catheter  in  the  femoral  vein)  5/1/12   67  

Lympha$c  duct  •   largest  vessel  of  the  lympha$c  system.    •  The  thoracic  duct  collects  LYMPH  from  the  CISTERNA  CHYLI  and  the  le8  upper  body,  and  drains  into  the  le8  subclavian  VEIN  to  deliver  lymph  to  the  bloodstream.    

•  a  distance  of  about  16  inches  long.  •  Rhythmically  contract  and  contains  valves  to  prevent  its  contents  from  back  flowing.      

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•  Muscular  movement,  such  as  occurs  with  physical  ac$vity  or  exercise,  massages  lymph  through  the  thoracic  duct  toward  the  subclavian  vein.  

•   Several  branches  of  lymph  vessels  feed  into  the  thoracic  duct  as  it  courses  through  the  chest,  rejoining  to  form  a  single  segment  that  intersects  with  the  subclavian  vein  beneath  the  clavicle.  

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It  collects  most  of  the  lymph  in  the  body  (except  that  from  the  right  arm  and  the  right  side  of  the  chest,  neck  and  head,  and  lower  le8  lobe  of  the  lung,  which  is  collected  by  the  right  lympha$c  duct)  and  drains  into  the  systemic  (blood)  circula$on  at  the  le8  brachiocephalic  vein  between  the  le8  subclavian  and  le8  internal  jugular  veins.  

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•  In  adults,  the  thoracic  duct  transports  up  to  4  L  of  lymph  per  day.  

•  The  lymph  transport  in  the  thoracic  duct  is  mainly  caused  by  the  ac$on  of  breathing,  aided  by  the  duct's  smooth  muscle  and  by  internal  valves  which  prevent  the  lymph  from  flowing  back  down  again.  

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When  the  thoracic  duct  is  blocked  or  damaged  a  large  amount  of  lymph  can  quickly  accumulate  in  the  pleural  cavity,  this  situa$on  is  called  chylothorax.  

The  first  sign  of  a  malignancy  (especially  an  intraabdominal  one)  may  be  an  enlarged  Virchow's  node,  a  lymph  node  in  the  le8  supraclavicular  area,  in  the  vicinity  where  the  thoracic  duct  emp$es  into  the  le8  subclavian  vein.  5/1/12   73  

Axillary  lymph  nodes  

The  Axillary  lymph  nodes  are  of  large  size,  vary  from  twenty  to  thirty  in  number,  and  may  be  arranged  in  the  following  groups:  

brachial  lymph  nodes  (or  "lateral")  pectoral  axillary  lymph  nodes  (or  "anterior")  subscapular  axillary  lymph  nodes  ("posterior")  central  lymph  nodes  apical  lymph  nodes  (or  "medial”  or  "subclavicular")  

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•  About  75%  of  lymph  from  the  breasts  drains  into  the  axillary  lymph  nodes,  making  them  important  in  the  diagnosis  of  breast  cancer.  

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Inguinal  Lymph  nodes  

•  Inguinal  lymph  node  is  a  type  of  lymph  node  in  the  inguinal  region.    

•  It  can  refer  to:  Superficial  inguinal  lymph  nodes  and  Deep  inguinal  lymph  nodes  

•  The  superficial  inguinal  lymph  nodes  form  a  chain  immediately  below  the  inguinal  ligament.  

•  The  superficial  nodes  drain  to  the  deep  inguinal  lymph  nodes.  

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Deep  inguinal  lymph    •  The  deep  inguinal  lymph  nodes  are  located  medial  to  the  femoral  vein  and  under  the  cribriform  fascia.    

•  There  are  approximately  3  to  5  deep  nodes.  The  superior-­‐most  node  is  located  under  the  inguinal  ligament  and  is  called  Cloquet's  node.  

•  The  presence  of  swollen  inguinal  lymph  nodes  are  an  important  clinical  sign  because  swelling  may  indicate  an  infec$on  spread  from  cancers,  such  as  anal  cancer  and  vulvar  cancer.  5/1/12   79  

Paraaor$c  LN  

•  The  paraaor/c  lymph  nodes  (also  known  as  para-­‐aor/c,  periaor/c,  peri-­‐aor/c,  and  lumbar)  are  a  group  of  lymph  nodes  that  lie  in  front  of  the  lumbar  vertebral  bodies  near  the  aorta.    

•  These  lymph  nodes  receive  drainage  from  the  lower  gastrointes/nal  tract  and  the  pelvic  organs.  

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