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Limb Vasculature
Organisation of the Body
| Question | Answer |
|---|---|
| Arteries of the arm | Subclavian artery - passes between middle 1/3 of clavicle Becomes the auxiliary artery at lateral edge of 1st rib Passes behind mid clavicle and becomes brachial artery at inferior edge of teres major Circumflex humeral artery Profunda brachii artery |
| Auxiliary artery | 1st part - superomedial to pectoralis minor 2nd part - posterior to pectoralis minor 3rd part - inferior to pectoralis minor |
| Arterial anastomosis around shoulder | Subclavian - suprascapular, dorsal scapular Axillary - circumflex scapular These can bypass obstructions of 1st/2nd axillary artery Can feel pulsation in brachial artery - humeral fractures! |
| Arteries of the forearm and hand | Palmar arches usually form anastomosis Deep palmar arch - usually radial Superficial palmar arch - usually ulnar Ulnar gives off interosseous arteries |
| Arterial blood gas | Radial artery blood sample Arteries sun deep so have to feel for pulse and insert needle deep Not done is Allens test indicated palmar supply is mostly radial |
| Large veins of upper limb | Subclavian vein - continuation of axillary vain from lateral 1st rib Axillary vein - sits anterior to axillary artery Basilic vein - pierces deep fascia to join brachial veins Cephalic vein - merges with axillary vein Median cubital vein - IV access |
| Cardiac pacemaker leads | Needs to be inserted into venous circulation Often at the point of joining just below the clavicle Cephalic vein - venosomy to insert pacemaker Can be inserted into axillary vein using Seldinger technique |
| The cubital fossa | A triangular region anterior to the elbow Borders of interepicondylar line, brachioradialis and pronator teres Contains biceps tendon, brachial artery, median nerve and superficial veins |
| The snuff box | Contains cephalic vein - site of IV access Dorsal venous network Extensor pollicis longus tendon Superficial radial nerve Radial artery Adductor pollicis longus tendon Extensor pollicis brevis |
| Lymphatic drainage of arm and breast | Axillary nodes - anterior and central Parasternal nodes - median Subdiaphragmatic nodes - inferior Subareolar lymphatic plexus |
| Sentinel lymph node biopsy | Inject dye into tumour See where lymphatic drainage moves to First lymph node reached is biopsied to test if tumour has metastasized |
| Arteries of the leg | Common iliac artery Internal iliac artery - pelvis and gluteal (gluteal arteries) External iliac artery Femoral circumflex arteries Profunda femoris artery - deep Femoral artery - superficial |
| Posterior compartment of thigh | Femoral pulse - back of knee Femoral artery is under Sartorius Subsartorial canal Can see perforating branches of profunda femoris Popliteal artery behind knee |
| Arteries of the lower leg | Femoral artery passes through adductor hiatus and becomes popliteal artery Posterior tibial artery - deep - enters foot as plantar ateries Anterior tibial artery - enters foot as dorsalis pedis artery Fibular artery |
| Intermittent claudication | When there us a compromised blood supply to a limb due to blockage of an artery Not seen at rest but causes pain in exercise |
| Veins of the lower limb | Saphenous veins originate from dorsal venous arch of foot Short - posterior to lateral malleolus with sural nerve ascending to popliteal fossa Long - anterior to medial malleolus with saphenous nerve ascending to femoral triangle |
| Varicose veins | Generally due to valve incompetence Veins tend to run superficial to deep - muscles around deep veins aid venous return Venous incompetence is often due to perforated valve - causes dilated veins prone to bleeding |
| Deep vein thrombosis | Venous pressure is low so blood is more likely to clot Clots can make it to the heart and lungs Presents as a unilateral swollen leg - often acute |
| Oedema of the lower limbs | Increased hydrostatic pressure - Ca channel blockers, heart failure, venous insufficiency, proximal DVT Reduced oncotic pressure - liver failure, nephrotic syndrome Lymphatic obstruction - post surgery, filariasis |
| Femoral triangle | Borders of inguinal ligament, sartorius and adductor longus Contains femoral nerve, artery and vein NAVY |
| Popliteal fossa | A diamond shaped region posterior to the knee Supracondylar fracture of femur can affect this Contains popliteal artery, vein and tibial nerve Borders of semimembranosus, semitendinosus, biceps femoris, gastrocnemius lateral and medial heads |
| Tarsal tunnel | T - Tibialis posterior D - Flexor digitorum longus A - Posterior tibial artery V - Vein N - Tibial nerve H - Flexor Hallucis longus Tom, Dick and Very Nervous Harry |
| List of upper limb arteries | Subclavian Axillary Brachial/profunda brachii artery Radial Ulnar Superficial and deep palmar arches |
| List of lower limb arteries | Common iliac Internal iliac External iliac Femoral/profunda femoris Popliteal Anterior tibial Posterior tibial Fibular Plantar |
| List of upper limb veins | Dorsal venous arch Cephalic Basilic Median cubital Axillary Subclavian Deep veins and venae comitantes |
| List of lower limb veins | Dorsal venous arch long saphenous Short saphenous Popliteal Femoral External iliac Internal iliac Common iliac Deep veins and venae comitantes |
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