Upper Limb vascular anatomy

Brachial Artery

• Continuation of the Axillary artery at the Lower Border of Teres Major
• Median nerve lateral to it but crosses obliquely in front at about the middle of the arm and lies on its medial side distally
• Ulnar nerve posterior to it above and then leaves it in the lower part of the arm to pass through the Medial Intermuscular Septum
• Passes into the Cubital Fossa before dividing into the Radial Artery and Ulnar Artery at the level of the neck of Radius
• Largest Branch of Brachial Artery: Profunda Brachii Artery
  • Leaves through the Triangular Interval (together with the Radial Nerve)
  • Runs in the radial groove with the Radial Nerve
  • Supplies: Triceps Brachii, Nutrient Artery to Humerus
  • Two terminal branches: Middle Collateral Artery and Radial Collateral Artery
    • Middle Collateral Artery – descends in the Medial Head of Triceps
    • Radial Collateral Artery – passes through the Lateral Intermuscular Septum together with the Radial Nerve
• Other Branches of Brachial Artery: Superior Ulnar Collateral Artery, Inferior Ulnar Collateral Artery, muscular branches to flexor muscles, Nutrient Artery to Humerus

Radial Artery

• Direct continuation of the Brachial Artery in the Cubital fossa
• Passes distally medial to Biceps Tendon
• Passes across Supinator
• Lies medially beside the superficial radial Nerve in the middle third
• Passes over tendon of insertion of Pronator Teres, radial head of Flexor Digitorum Superficialis, origin of the Flexor Pollicis Longus, insertion of Pronator Quadratus, and lower end of the Radius
• In upper forearm, overlapped anteriorly by Brachioradialis
• Disappears deep to the tendons of Abductor Pollicis Longus and Extensor Pollicis Brevis to across the Anatomical Snuff Box

Ulnar Artery

• Disappears from Cubital Fossa by passing deep to deep head of Pronator Teres, beneath the fibrous arch of the Flexor Digitorum Superficialis and Median Nerve

• Runs medially and distally on Flexor Digitorum Profundus

• Lies laterally beside the Ulnar Nerve in the distal 2/3 of the forearm

• Passes down over front of wrist into palm, lying anterior to Flexor Retinaculum

• Continues as the Superficial Palmar Arch

• Ulnar pulse can be palpated on radial side of the Flexor Carpi Ulnaris tendon above the Pisiform Bone

• Branches: Common Interosseous Branch

• Common Interosseous Branch

  • Divides into Anterior Interosseous Artery and Posterior Interosseous Artery
  • Anterior Interosseous Artery:
    • Lies deeply on Interosseous Membrane
    • Lies between Flexor Digitorum Profundus and Flexor Pollicis Longus
    • Perforating branches pierce membrane to supply deep extensor muscles
    • Gives Nutrient branches to Radius and Ulna
    • Passes posteriorly through the Interosseous Membrane at the level of the upper border of Pronator Quadratus
    • Ends on the back of the wrist in the Dorsal Carpal Arch
  • Posterior Interosseous Artery:
    • Accompanies the Posterior Interosseous Nerve
    • Assisted by branches of the Anterior Interosseous Artery that pierce the Interosseous membrane
    • Later replaced by the Anterior Interosseous Artery – which pierces the membrane to enter extensor compartment

Wrist Anastomosis

• Both Radial and Ulnar Arteries give off Palmar Carpal branches and Dorsal Carpal branches
• Anastomose with each other deep to the long tendons forming Palmar Carpal Arch and Dorsal Carpal Arch
• Palmar Carpal Arch:
  • Lies transversely across wrist joint
  • Supplies carpal bones
  • Sends branches distally into the hand to anastomose with the Deep Palmar Arch
• Dorsal Carpal Arch:
  • Lies transversely across the distal row of carpal bones
  • Sends Dorsal Metacarpal Arteries distally into each Metacarpal space
    • These divide to supply fingers
    • Anastomose through the interosseous spaces with the Deep Palmar Arch and digital branches of the Superficial Palmar Arch

Upper Limb Veins

Good video: https://www.youtube.com/watch?v=0bBHUcGK7P0&ab_channel=AnatomyZone

• Hand
  • Dorsal
    • Dorsal digital veins →
    • Dorsal metacarpal veins →
    • Dorsal venous network
  • Palmer
    • Palmer digital veins
    • Palmer venous network
• Forearm
  • Dorsal venous network drains into
    • Cephalic vein - lateral
    • Basilic vein - medial
  • Palmer venous network drain into
    • Median antebrachial vein
• Cubital fossa
  • The cephalic, bascilic and median antebrachial vein meet
• Arm
  • Cephalic vein
    • Continues up lateral arm
    • Passes lateral to the bicepts muscle
    • Passes in the deltopectoral groove between deltoid and pec major
    • Pieces the clavipectoral fascia in the deltopectoral triangle to drain into the subclavian vein
      • Deltopectoral triangle borders
        • Clavicle
        • Pac major
        • Deltoid
  • Basilic vein
    • Continues up medial arm
    • Pieces the brachial fascia to enter the deep compartment of the arm to drain into the deep brachial veins
      • Deep brachia vein are paired veins the accompany the brachial artery
      • At the lower border of teres major it becomes the Axillary vein
• Axilla
  • Axillary vein
    • Starts where the Basilic vein drains into the deep brachial vein at the lower border of teres major
    • Receives:
      • Cephalic vein ( at deltopectoral groove)
      • Basilic + brachial veins (forming its origin)
    • Continues as:
      • Subclavian vein at lateral border of 1st rib
• Subclavian vein
  • Joins internal jugular vein behind sternoclavicular joint
  • Forms the brachiocephalic vein → drains into superior vena cava
• Deep system of the arm
  • These are Venae comitantes (accompany veins - which follow the arterial anatomy)
    • Deep palmer arch drain into
    • Radial and ulnar veins which drain into
    • Paired Brachial veins