VASCULAR SUPPLY TO UPPER EXTREMITY ARTERIES

Subclavian Arteries Left subclavian: Left subclavian: Direct branch from aortic arch Direct branch from aortic arch Right subclavian: Right subclavian: Branch from brachiocephalic Branch from brachiocephalic

Subclavian Branches Vertebral artery Vertebral artery Passes through transverse foramina 6-1 Passes through transverse foramina 6-1 Passes through foramen magnum Passes through foramen magnum Unites with opposite vertebral artery to form basilar artery Unites with opposite vertebral artery to form basilar artery

Subclavian Branches Thyrocervical trunk Thyrocervical trunk Suprascapular a. Suprascapular a. Passes btw sternomastoid and ant. Scalene muscles Passes btw sternomastoid and ant. Scalene muscles Passes over suprascapular lig. Passes over suprascapular lig. To supraspinous fossa To supraspinous fossa Through spinoglenoid notch Through spinoglenoid notch To infraspinous fossa To infraspinous fossa

Subclavian Branches Thyrocervical trunk Thyrocervical trunk Transverse cervical artery: Transverse cervical artery: Passes ant to scalenus ant muscle Passes ant to scalenus ant muscle Runs with CN IX Runs with CN IX Supplies rhomboids Supplies rhomboids Inferior thyroid artery: Inferior thyroid artery: Variable Variable

Subclavian Branches Internal thoracic: Internal thoracic: Gives off ant. Intercostals in intercostal spaces Gives off ant. Intercostals in intercostal spaces

Subclavian Artery Passes between first rib and clavicle and is renamed the axillary artery. Passes between first rib and clavicle and is renamed the axillary artery. Runs across subclavian groove behind anterior scalene muscle. Runs across subclavian groove behind anterior scalene muscle.

Axillary Artery Begins at inferior border of first rib. Begins at inferior border of first rib. Divided into thirds by pectoralis minor muscle: Divided into thirds by pectoralis minor muscle: First part superior to muscle. First part superior to muscle. Second part deep to muscle. Second part deep to muscle. Third part inferior to muscle. Third part inferior to muscle.

First Part of Axillary Artery Superior thoracic artery: Superior thoracic artery: Supplies posterior aspects of intercostal spaces 1 and 2 and part of serratus anterior Supplies posterior aspects of intercostal spaces 1 and 2 and part of serratus anterior

Second Part of Axillary Artery Thoracoacromial artery (trunk): Thoracoacromial artery (trunk): Pectoral branch Pectoral branch Deltoid branch Deltoid branch Acromial branch Acromial branch Clavicular branch Clavicular branch

Second Part of Axillary Artery Lateral thoracic artery: Lateral thoracic artery: Extends along lateral side of pectoralis minor. Extends along lateral side of pectoralis minor. Supplies part of pectoral muscles, lymph nodes and breast (esp. important in women) Supplies part of pectoral muscles, lymph nodes and breast (esp. important in women)

Third Part of Axillary Artery Posterior circumflex humeral: Posterior circumflex humeral: Passes around posterior aspect of surgical neck of humerus. Passes around posterior aspect of surgical neck of humerus. Anastomoses with the anterior circumflex humeral. Anastomoses with the anterior circumflex humeral.

Third Part of Axillary Artery Posterior circumflex humeral: Posterior circumflex humeral: Runs with axillary nerve. Runs with axillary nerve. Supplies deltoid and triceps muscles Supplies deltoid and triceps muscles Part of contents of quadrilateral space. Part of contents of quadrilateral space.

Third Part of Axillary Artery Anterior circumflex humeral: Anterior circumflex humeral: Subscapular: Subscapular: Thoracodorsal: Thoracodorsal: Latissimus muscle Latissimus muscle Circumflex scapular: Circumflex scapular:

Brachial Artery Continuation of axillary artery at inferior border of teres major muscle. Continuation of axillary artery at inferior border of teres major muscle.

Branches of Brachial Artery Deep brachial (profunda brachii): Deep brachial (profunda brachii): Wraps around posterior surface of humerus. Wraps around posterior surface of humerus. Runs in radial groove with radial nerve. Runs in radial groove with radial nerve. Supplies posterior compartment of brachium. Supplies posterior compartment of brachium.

Branches of Brachial Artery Deep brachial (profunda brachii): Deep brachial (profunda brachii): Branches: Branches: Ascending branch to posterior circumflex humeral artery. Ascending branch to posterior circumflex humeral artery. Descending branch becomes radial collateral. Descending branch becomes radial collateral. Anastomoses with radial recurrent. Anastomoses with radial recurrent.

Branches of Brachial Artery Nutrient humeral artery. Nutrient humeral artery. Superior ulnar collateral: Superior ulnar collateral: Runs with ulnar nerve. Runs with ulnar nerve. Passes posterior to medial epicondyle. Passes posterior to medial epicondyle. Anastomoses with posterior ulnar recurrent artery. Anastomoses with posterior ulnar recurrent artery.

Branches of Brachial Artery Nutrient humeral artery. Nutrient humeral artery. Inferior ulnar collateral: Inferior ulnar collateral: Passes anterior to medial epicondyle. Passes anterior to medial epicondyle. Anastomoses with anterior ulnar recurrent artery. Anastomoses with anterior ulnar recurrent artery.

Brachial Artery Runs medial to median nerve in upper part of arm. Runs medial to median nerve in upper part of arm. Runs lateral to median nerve in lower part of arm. Runs lateral to median nerve in lower part of arm. Passes deep to bicipital aponeurosis lateral to median nerve and medial to bicipital tendon. Passes deep to bicipital aponeurosis lateral to median nerve and medial to bicipital tendon.

Brachial Artery Branches into radial and ulnar arteries. Branches into radial and ulnar arteries.

Radial Artery Gives off radial recurrent to radial collateral from deep brachial. Gives off radial recurrent to radial collateral from deep brachial. Enters wrist and hand to form deep palmar arch. Enters wrist and hand to form deep palmar arch.

Ulnar Artery Gives off common interosseous artery (trunk) near its origin. Gives off common interosseous artery (trunk) near its origin. Runs through antebrachium with ulnar nerve. Runs through antebrachium with ulnar nerve. Enters wrist and hand to form superficial palmar arch. Enters wrist and hand to form superficial palmar arch.

Ulnar Artery Common interosseous artery gives off anterior and posterior interosseous arteries: Common interosseous artery gives off anterior and posterior interosseous arteries: Run on either side of the interosseous membrane in the antebrachium. Run on either side of the interosseous membrane in the antebrachium.

VASCULAR SUPPLY TO UPPER EXTREMITY VEINS

Venous Drainage of UE Trace veins back to heart. Trace veins back to heart. Venous drainage begins with dorsal venous arch which receives blood from digits. Venous drainage begins with dorsal venous arch which receives blood from digits. Cephalic vein drains lateral side of dorsal venous arch. Cephalic vein drains lateral side of dorsal venous arch. Basilic vein drains medial side of dorsal venous arch. Basilic vein drains medial side of dorsal venous arch.

Cephalic Vein Runs along lateral side of antebrachium in superficial fascia. Runs along lateral side of antebrachium in superficial fascia. Receives tributaries from median vein near the level of the elbow. Receives tributaries from median vein near the level of the elbow. Runs along lateral side of brachium in superficial fascia. Runs along lateral side of brachium in superficial fascia. Runs through deltopectoral triangle. Runs through deltopectoral triangle. Pierces clavipectoral fascia. Pierces clavipectoral fascia. Dumps into axillary vein. Dumps into axillary vein.

Basilic Vein Runs along medial side of antebrachium. Runs along medial side of antebrachium. Receives median cubital vein drainage. Receives median cubital vein drainage. Median cubital vein lies superficial to bicipital aponeurosis: Useful site for venipuncture. Runs in deep fascia along medial side of brachium. Runs in deep fascia along medial side of brachium. Joins with venae comitantes to form axillary vein. Joins with venae comitantes to form axillary vein.

Axillary Vein Formed by union of basilic vein and venae comitantes. Formed by union of basilic vein and venae comitantes. Renamed subclavian vein after it passes under clavicle. Renamed subclavian vein after it passes under clavicle.

Subclavian Vein Forms brachiocephalic vein along with jugular veins. Forms brachiocephalic vein along with jugular veins. Note: there are two brachiocephalic veins but only one brachiocephalic artery. Note: there are two brachiocephalic veins but only one brachiocephalic artery. The two brachiocephalic veins come together to form the superior vena cava. The two brachiocephalic veins come together to form the superior vena cava.

Lymphatics Lymphatic drainage is from palmar surface to dorsal surface of hand. Lymphatic drainage is from palmar surface to dorsal surface of hand. Laterally: Laterally: Lymphatics follow cephalic vein to: Chain of nodes in deltapectoral groove to: Axillary nodes. Medially: Medially: Lymphatics flow to epitrochlear nodes to: Axillary nodes.

Lymph Nodes Brachial: Brachial: Lie medial to humerus near axillary artery and vein. Pectoral: Pectoral: Lie behind pectoralis minor with lateral thoracic artery. Drain mammary gland.

Lymph Nodes Subscapular: Subscapular: Lie along lower border of scapula with subscapular artery. Drain back. Central nodes: Central nodes: In axillary fat. Receive lymph from all the above nodes. Drain to: Apical nodes behind clavicle. Apical nodes behind clavicle.