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Vasculature of the upper limb By: Angelina Patel Arterial Supply: ž Arterial supply of the upper limb can be divided into 5 main vessels : ž 1) subclavian artery ž 2) axillary artery 3) Brachial artery 4) Radial artery 5) Ulnar artery 2 Arterial Supply of the upper limb- key landmarks So vasculature begins at the subclavian artery. Once it goes past the lateral border of the 1 rib into the axilla to become the axillary artery. Axillary artery becomes the brachial once it passes past the lower border of the teres major muscle The brachial artery will then descend down the arm and once it reaches the cubital fossa bifurcates and gives off 2 branches the ulnar and radial arteries. The ulnar artery continues anteromedially and the radial artery posteriorly. Both arteries will anatomose to form 2 arches. Ulnar- gives off the sUperficial palmar arch. Radial – gives of the Deep palmar arch 3 Key branches and Clinical Significance ž 1) Axillary artery-à gives off the anterior and posterior circumflex humeral arteries. These wrap around surgical neck of the humerus bone in the upper arm- à thus in fractures of the surgical neck can be damaged and cause avascular necrosis ž 2) Brachial artery-à gives of the profundi brachii artery. Occlusion of the brachial artery can lead to necrosis of the muscles- à muscle fibres replaces by scar tissue causing Volkmann’s Ischaemic Contracture ž 3) Ulnar artery- gives of the anterior and posterior interosseous arteries which supply the deeper muscles of the forearm such as pronator quadratus etc ž 4) Radial artery- moves posteriorly and enters the anatomical snuffbox. Important landmark when there is FOOSH fracture à falling upon an outstretched hand. 45 SBA 1 Brachial artery- profundi brachii What is the name of the artery Axillary artery- anterior and posterior once it passes the lower border circumflex humeral arteries of teres major and name one of its branches: Brachial artery- anterior interosseus Subclavian artery 6 SBA 1 Brachial artery- profundi brachii What is the name of the artery Axillary artery- anterior and posterior once it passes the lower border circumflex humeral arteries of teres major and name one of its branches: Brachial artery- anterior interosseus Subclavian artery 7 SBA 2 Radial artery A patient has come in with their forearm pronated, thumb Ulnar artery adducted and elbow flexed. You suspect this is a Volkmann Ischaemic Contracture. Damage Axillary artery to which artery has caused this? Brachial artery 8 SBA 2 A patient has come in with their Radial artery forearm pronated, thumb adducted and elbow flexed. You Ulnar artery suspect this is a Volkmann Ischaemic Contracture. Damage to which artery has caused this? Axillary artery Brachial artery 9 Palpating pulses of the upper limb ž 1) Radial-à on the palmar side and lateral aspect of the forearm near the wrist joint where you should feel a groove. ž 2) Ulnar-à at the wrist lateral to flexor carpi ulnaris ž 3) Brachial-à located the bicep tendon in the antecubital fossa and slightly flex and forearm so it can be palpated more easily. SBA 3 Which artery is the arrow pointing to in this dissection circled in blue? Radial artery Ulnar artery Axillary artery Brachial artery 11 SBA 3 Which artery is the arrow pointing to in this dissection circled in blue? Radial artery Ulnar artery Axillary artery Brachial artery 12 Venous supply of the upper limb- Superficial veins ž 1) Cephalic- this arises from the dorsal venous network of the hand and travels laterally and anteriorly. At the shoulder the vein travels between the deltoid and pectoralis major muscle and enters the axilla. This region is called the clavipectoral triangle. There the cephalic drains into the axillary vein ž 2) Basilic- ascends medially and then at the border of the teres major travels posteriorly to drain into the brachial veins Clinical Significance- Venepuncture ž Venepunctures can be used for many reasons such as obtaining blood samples etc. The median cubital vein which is present in the cubital fossa and connects the cephalic and basilic veins together is the most commonly used vein. ž This is because it is superficial so easy to access and is fixed in place by other perforating veins that arise from the deep veins of the upper limb Venous supply of the upper limb – Deep Veins ž Deep Veins share the same names as the arteries they accompany – this is known as venous comitantes. ž Perforating veins arise from the deep veins and will connect the 2 systems SBA 4 Axillary vein- brachial and subclavian Your on placement and have been asked to carry out venepuncture on a Medial Cubital Vein- Cephalic and patient. Which vein is commonly used basilic in this procedure and what 2 veins Median Cubital Vein- Cephalic and does it connect? Brachial Radial vein- Ulnar and Brachial 16 SBA 4 Axillary vein- brachial and subclavian Your on placement and have been asked to carry out Medial Cubital Vein- Cephalic and venepuncture on a patient. basilic Which vein is commonly used in Median Cubital Vein- Cephalic and this procedure and what 2 veins Brachial does it connect? Radial vein- Ulnar and Brachial 17Thank you for listening! Any questions my email is: PatelA53@cardiff.ac.uk