1: arteries 1 - wiley...1 1 coronary arteries 2 ascending & arch of aorta 4 internal carotid...

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1

Coronary arteries 2Ascending & arch of aorta 4Internal carotid artery, vertebrobasilar

system & circle of Willis 8Ophthalmic artery 10External carotid artery 12Maxillary artery 14Middle meningeal artery 14Subclavian artery 16Axillary artery 20Brachial artery 22Radial artery 24Ulnar artery 26

Thoracic (descending) aorta 28Abdominal aorta 30External iliac artery 30Coeliac trunk 32Superior mesenteric artery 34Inferior mesenteric artery 34Internal iliac artery 36Femoral artery 36Popliteal artery 38Anterior tibial artery 38Posterior tibial artery 40Fibular (peroneal) artery 42Arterial anastomoses around scapula 44Arterial anastomoses around hip 45

1: ARTERIES

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COPYRIG

HTED M

ATERIAL

Coronary arteries ARTERIES

2

1Circumflex

Leftmarginal

Diagonal

Anteriorinterventricular

Septal

Leftcoronary

Sinuatrialnodal

Rightatrial

Posteriorinterventricular

Rightmarginal

Atrio-ventricularnodal

Rightconus

Leftconus

Left atrial

Rightcoronary

Sup

Inf

R L

Coronary arteries

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CORONARY ARTERIESFrom: Ascending aortaTo: Myocardium

Right coronary artery. Originates from theanterior aortic sinus. It passes anteriorlybetween the pulmonary trunk and the rightauricle to reach the atrioventricular sulcus inwhich it runs down the anterior surface ofthe right cardiac border and then onto theinferior surface of the heart. It terminates atthe junction of the atrioventricular sulcusand the posterior interventricular groove byanastomosing with the circumflex branch of the left coronary artery and giving off the posterior interventricular (posteriordescending) artery. It supplies the rightatrium and part of the left atrium, thesinuatrial node in 60% of cases, the rightventricle, the posterior part of the inter-ventricular septum and the atrioventricularnode in 80% of cases.

Left coronary artery. Arises from the leftposterior aortic sinus. It passes laterally,posterior to the pulmonary trunk andanterior to the left auricle to reach the

atrioventricular groove where it divides into an anterior interventricular (formallyleft anterior descending) artery andcircumflex branches. The circumflex arteryruns in the atrioventricular sulcus around the left border of the heart to anastomosewith the right coronary artery. The anteriorinterventricular artery descends on theanterior surface of the heart in the anteriorinterventricular groove and around the apex of the heart into the posterior interven-tricular groove where it anastomoses withthe posterior interventricular branch of theright coronary artery. The left coronaryartery supplies the left atrium, left ventricle,anterior interventricular septum, sinuatrialnode in 40% of cases and the atrioven-tricular node in 20%.

Dominance. In approximately 10% of heartsthe posterior interventricular artery arisesfrom the circumflex artery (left coronary)and then most of the left ventricle andinterventricular septum are supplied by theleft coronary artery. The heart is said to haveleft cardiac dominance.

ARTERIES Coronary arteries

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1

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Ascending & arch of aorta ARTERIES

4

1Internalcarotid

Externalcarotid

ArteriathyroideaimaRight

commoncarotid

Rightsubclavian

Brachiocephalic

Leftsubclavian

Left commoncarotid

Sup

Inf

R L

Ascending & arch of aorta

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ASCENDING & ARCH OF AORTAFrom: Left ventricleTo: Descending aorta

Ascending aorta. Arises at the vestibule ofthe left ventricle at the level of the third leftcostal cartilage and passes upwards andslightly to the right to a point behind thesternum at the level of the manubriosternaljoint (second costal cartilage) where itbecomes the arch of the aorta. It is enclosedin fibrous and serous pericardium. Anteriorto it are the right auricle, the infundibulumof the right ventricle and pulmonary trunk.Posterior, lie the left atrium, the rightpulmonary artery and right main bronchus.To the left lie the pulmonary trunk and theleft auricle. To the right are the superior venacava and the right atrium.

Arch of aorta. The arch begins posterior tothe manubriosternal joint at the level of thesecond costal cartilage and passes posteriorand to the left, over the left main bronchus to end at the left side of the body of T4vertebra. Its highest level is the mid point ofthe manubrium sterni and at this level itsthree main branches emerge. Anterior and to the left of the arch are (from anterior toposterior) the left phrenic nerve, vagal andsympathetic contributions to the cardiacplexus, and the left vagus. Also, the leftsuperior intercostal vein runs forwards onthe arch anterior to the vagus and posterior

to the phrenic nerve. Lateral to all thesestructures are the pleura and left lung.Posterior and to the right of the arch are thetrachea, deep cardiac plexus, left recurrentlaryngeal nerve, oesophagus, thoracic ductand the body of T4. Inferior to the arch arethe pulmonary bifurcation, the left mainbronchus, the ligamentum arteriosum andthe left recurrent laryngeal nerve. From itssuperior surface emerge the brachiocephalicartery, the left common carotid and leftsubclavian arteries. Within the adventitia of the ascending and arch of the aorta liebaro- and chemoreceptors.

Brachiocephalic artery. Arises from theconvexity of the aortic arch behind themanubrium sterni and passes upwards andposteriorly to the right. It divides into theright subclavian and right common carotid arteries posterior to the rightsternoclavicular joint. Anterior to it are theleft brachiocephalic vein with the rightinferior thyroid vein entering it, and thethymic remnants. The artery initially liesanterior to the trachea then passes to lie onits right lateral side. On the right of theartery are the right brachiocephalic vein,upper part of the superior vena cava, thepleura and the cardiac branches of the vagus.The main vagal trunk is more posterolateral.At the origin of the brachiocephalic arterythe left common carotid artery liesposteriorly on its left.

ARTERIES Ascending & arch of aorta

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continued

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Ascending & arch of aorta ARTERIES

6

1Internalcarotid

Externalcarotid

ArteriathyroideaimaRight

commoncarotid

Rightsubclavian

Brachiocephalic

Leftsubclavian

Left commoncarotid

Sup

Inf

R L

Ascending & arch of aorta

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Common carotid arteries. The right common carotid artery arises from thebrachiocephalic artery as it divides posteriorto the right sternoclavicular joint, whilst the left common carotid arises from theconvexity of the aortic arch. Both end as thearteries bifurcate at the level of the upperborder of the thyroid cartilage (C4).

Left common carotid artery (thorax). Lyinganterior to the thoracic part of this artery arethe left brachiocephalic vein and the thymicremnant. Posterior to it in its lower part arethe left subclavian artery and the tracheawhilst further superiorly there is the leftrecurrent laryngeal nerve, the thoracic ductand the left side of the oesophagus. On itsright at its origin is the brachiocephalicartery but as it ascends the inferior thyroidveins and the trachea come to lie on its right

side. To its left lie the vagus, the left phrenicnerve and the left pleura and lung.

Both common carotid arteries (cervical).Ascend in the neck slightly laterally from apoint posterior to the sternoclavicular jointto end at the level of the upper border of thethyroid cartilage (C4) at which point there is a dilatation—the carotid sinus (abaroreceptor). On the posterior aspect of the bifurcation there is the carotid body (achemoreceptor). Lying between left and rightarteries, and medial to each, progressivelyfrom below are the trachea, recurrentlaryngeal nerves, thyroid gland, larynx andpharynx. Each artery lies in its carotid sheathwith the internal jugular vein lateral to it andthe vagus nerve between and posterior tothem both.

ARTERIES Ascending & arch of aorta

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Internal carotid artery ARTERIES

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1

Dura

OrbitalFrontalParietal

Heubner'srecurrentstriate

Anterior communicating

Anteriorcerebral

Ophthalmic

Internal carotid

Middlecerebral

Medial andlateral striate

Superiorcerebellar

PontineBasilar

Anteriorspinal

Posterior spinal

Labyrinthine

Hypophyseal

Anterior choroidal

Posterior choroidal

FrontalParietalTemporal

TemporalOccipitalParieto-occipital

Medullary

(anterior andposterior branches)

ANTERIORCIRCULATION

POSTERIORCIRCULATION

branches

Anterior inferior cerebellar

Posterior inferior cerebellar

Carotid canal

Posteriorcerebral

Posterior communicating

Vertebral

Ant

Post

L R

Internal carotid, vertebrobasilar system & circle of WillisNote: (1) Labyrinthine usually arises from anterior inferior cerebellar; (2) posterior spinal maycome from vertebral

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INTERNAL CAROTID ARTERY,VERTEBROBASILAR SYSTEM &CIRCLE OF WILLISFrom: Bifurcation of the common carotid

arts (C4) & first parts of subclavian artsTo: Terminal brs

The internal carotid artery angles from thebifurcation slightly posteriorly to reach thecarotid canal through which it enters theskull to end as middle and anterior cerebralarteries. At its origin it possesses a dilatationin which lie the carotid sinus and body. In the neck it is crossed laterally by, from below up, the pharyngeal branch of the vagus (X), glossopharyngeal nerve (IX),stylopharyngeus and styloglossus. It lies onthe pharyngeal wall and the pharyngobasilarfascia. Within the carotid canal it turns 90degrees anteromedially to run through thepetrous temporal bone where it lies medial to the middle ear. It then turns 90 degreessuperiorly to pass across the upper limit of the foramen lacerum. It then turns 90degrees anteriorly to pass forwards, lateralto the body of the sphenoid which it grooves.Here it lies in the medial wall of thecavernous sinus with the abducent nerve (VI) on its lateral side. At the anterior end of the cavernous sinus it turns 90 degreessuperiorly then 90 degrees posteriorly topass medial to the anterior clinoid processand lateral to the pituitary stalk and opticchiasma. It ends as terminal branches on themedial surface of the temporal lobe.

Anterior cerebral artery is formed by thebifurcation of the internal carotid artery. Itpasses anteriorly over the optic nerve to archover the genu of the corpus callosum on themedial aspect of the cerebral hemisphereswhere it ends as terminal branches.

Middle cerebral artery is formed by thebifurcation of the internal carotid artery. Itruns laterally into the sylvian fissure thenposterosuperiorly in the sulcus where itdivides into terminal branches.

Basilar artery is formed by the junction ofthe left and right vertebral arteries (seesubclavian artery, pp. 16–19) anterior to theupper medulla. From there it ascends lyingangled forwards between the pons and theclivus in a slight depression on the anteriorsurface of the pons. It terminates at the upperborder of the pons as posterior cerebralarteries.

Posterior cerebral artery is formed by thebifurcation of the basilar artery. It passeslaterally around the cerebral peduncle to runposteriorly above the tentorium cerebelli onthe inferomedial surface of the occipital lobewhere it divides into terminal branches.

(Other branches of the internal carotidartery, not illustrated, are caroticotympanic,pterygoid and cavernous arteries.)

ARTERIES Internal carotid artery

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Ophthalmic artery ARTERIES

10

1 Optic canal

Optic nerve

Posterior ethmoidal canal

Anterior ethmoidal canal

Central retinal

LacrimalPosterior ethmoidal

Anterior ethmoidal

Dorsal nasal

Supratrochlear

Supra-orbital

Muscularbranches

Ciliarybranches

Post

Ant

R L

Ophthalmic arteryNote: Right side viewed from above

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OPHTHALMIC ARTERYFrom: Internal carotid artTo: Terminal brs in orbit

It arises from the internal carotid artery as itlies medial to the anterior clinoid processand runs anteriorly through the optic canalwithin the optic nerve’s dural sheath, lyinginferolateral to the nerve. Small branchessupply the proximal nerve. In the orbit theartery leaves the dural sheath and passesforwards around the lateral side of the nerveto cross anterior to it to reach the medialorbit. It then continues medially betweensuperior oblique and medial rectus to passout of the cone of muscles to reach themedial wall of the orbit. The arterycontinues forwards to terminate at the

medial orbital border deep to the superiortarsal plate as branches which leave the orbitto anastomose with branches of the facialartery.

Central retinal artery. This small, importantend artery supplies the optic nerve andretina. It leaves the ophthalmic artery belowthe optic nerve and then, half way along theorbital part of the optic nerve, enters first thedural sheath and then the nerve itself.

(Other branches, not illustrated, (1) ofophthalmic artery are anterior meningealand medial palpebral arteries; (2) of lacrimalartery are lateral palpebral, zygomatic andrecurrent meningeal arteries; (3) of muscularis anterior ciliary artery.)

ARTERIES Ophthalmic artery

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External carotid artery ARTERIES

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1

Tonsillar

ParietalFrontal

Transverse facial

Ascendingpalatine

Superior labial

Inferior labial

Submental

Deep lingual

Dorsal lingual

Sublingual

Infrahyoid

Superior laryngeal

Cricothyroid

Superior thyroid

Stylomastoidbranch

Sternocleidomastoidbranch

Posteriorauricular Maxillary

Occipital

Ascendingpharyngeal

Superiorthyroid

Lingual

Facial

Superficialtemporal

Greater cornu of hyoid and hyoglossus

Angle of mandible and masseter

Sup

Inf

Post Ant

External carotid artery

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EXTERNAL CAROTID ARTERYFrom: Upper border of thyroid cartilage (C4)To: Terminal brs within parotid gland post

to neck of mandible

The artery arises within the carotid sheathfrom the bifurcation of the common carotidartery. It lies at first anteromedial to theinternal carotid artery but spirals over it tocome to lie lateral to it at the level of C2.Initially, it angles slightly forwards thencurves backwards as it ascends to enter theparotid gland between deep and superficiallobes. During its course it is crossed by, frombelow upwards: the upper root of the ansacervicalis, the hypoglossal nerve, theposterior belly of digastric, stylohyoid, thestylohyoid ligament and the facial nerve(within the parotid). Passing between it andthe internal carotid artery are, from belowupwards, the pharyngeal branch of the vagus (X), glossopharyngeal nerve (IX),stylopharyngeus and styloglossus. It lies on,from below upwards, pharyngeal wall,superior laryngeal branch of the vagus (X)and deep parotid lobe.

Superior thyroid artery. Arises from theanterior surface of the external carotid arterynear its origin and runs inferiorly andforwards deep to omohyoid and lateral tothe inferior constrictor and externallaryngeal nerve to reach the upper pole of thethyroid gland.

Lingual artery. Runs superiorly looping overthe greater cornu of the hyoid bone andpasses medially (deep) to hyoglossus theninto the substance of the tongue.

Facial artery. Arises from the anteromedialsurface of the external carotid artery andruns above the hyoid bone deep to digastricand passes upwards to reach the posteriorsurface of the submandibular gland which it grooves deeply, lying medial to the body of the mandible. Here it lies on superiorconstrictor, directly lateral to the palatinetonsil. It then follows a tortuous courselooping at first inferiorly then upwardsaround the lower border of the mandible tocross the bone anterior to the insertion ofmasseter (where it is easily palpable). It thenruns in the superficial tissues of the facetowards the angle of the mouth where itturns superiorly towards the medial canthusof the eye. (Other branches, not illustrated,are glandular (to submandibular gland) andlateral nasal arteries.)

Superficial temporal artery. Runs superiorlybetween the deep and superficial lobes of the parotid gland, over the posterior end of the zygomatic process (where it is easily palpable) and terminates in thesubcutaneous tissues of the lateral scalp.

ARTERIES External carotid artery

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Maxillary artery ARTERIES Middle meningeal artery

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1

BuccalMuscular

Accessory meningeal

Middlemeningeal

Anteriortympanic

Deepauricular

Mylohyoid

Inferior alveolar

Deep temporal

Infra-orbital

Posterior superioralveolar

Sphenopalatine

Greater palatine

Lesser palatine

Pharyngeal

Foramen ovale

Foramenspinosum

Squamotympanicfissure

Inferior alveolar foramen

Lateral pterygoid

Palatovaginal canal

Infra-orbitalfissure

Sphenopalatine foramen

Greater palatine foramen

Lesser palatine foramen

Sup

Inf

Post Ant

Maxillary artery

Anterior division

Posteriordivision

Superiortympanicbranch

Ganglionic branch

Pterion

Foramen spinosumAuriculotemporal nerve

Sup

Inf

Post Ant

Middle meningeal artery

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MAXILLARY ARTERYFrom: External carotid within parotid glandTo: Terminal brs in pterygopalatine fossa

It arises from the external carotid arterywithin the parotid gland posterior to theneck of the mandible and ends as thesphenopalatine artery. The artery is dividedinto three portions by its relationshipposterior, in, or anterior to the lateralpterygoid muscle. The first part passes deepto the neck of the mandible between the boneand the sphenomandibular ligament andruns anteriorly lateral to the inferior alveolarnerve to reach the border of the lateralpterygoid. The second part anglesanteromedially between the two heads oflateral pterygoid between anterior andposterior divisions of the mandibular nerve.The third part leaves the lateral pterygoid toenter the pterygopalatine fossa where it

terminates as branches which accompany thebranches of the maxillary division of thetrigeminal nerve (Vb).

Inferior alveolar artery. Passesinferolaterally posterior to the inferioralveolar nerve onto the medial surface of theramus of the mandible which it grooves as itenters the inferior alveolar (mandibular)foramen in the mandible. It is distributedalong the mandibular canal to the lower jawand teeth. Its terminal branch appears as themental branch through the mental foramen.

(Other branches, not illustrated, (1) ofmaxillary artery (third part) is artery ofpterygoid canal; (2) of inferior alveolarartery are dental and mental; (3) ofinfraorbital artery are dental and anteriorsuperior alveolar; (4) of posterior superioralveolar artery is dental.)

Maxillary artery ARTERIES Middle meningeal artery

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MIDDLE MENINGEAL ARTERYFrom: First part of maxillary artTo: Terminal brs

It arises from the superomedial surface of themaxillary (first part) to run between the tworootlets of the auriculotemporal nerve as itpasses vertically into the foramen spinosumin the greater wing of the sphenoid bone.After a very short course laterally over thegreater wing of the sphenoid in the middlecranial fossa it divides into anterior andposterior divisions. The anterior divisionruns anterolaterally on the floor of themiddle cranial fossa beneath the dura materand grooves the greater wing of the sphenoidas it passes upwards to the junction of thelesser and greater wings. Here it may groove

deeply or tunnel through the bone at theapex of the greater wing. It passes across theinner aspect of the pterion onto the parietalbone. The posterior division runs almosthorizontally posterolateral over the inneraspect of the squamous temporal bone ontothe lower parietal bone where it givesterminal branches.

Because of the problem of extraduralhaemorrhage caused by damage to thisartery, the surface anatomy is important.Anterior branch: 3cm above mid point ofzygomatic arch. Posterior branch: on a linevertically from the mastoid process andhorizontal from the upper margin of theorbit.

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Subclavian artery ARTERIES

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1

Anteriorintercostal1-6


Phrenic branch

Pericardiacophrenic

Lateral borderof first rib

Scalenusanterior

Vagus nerve

Recurrent laryngealnerve

Thyrocervical trunk

Inferior thyroid

Superior epigastric

Musculophrenic

Internal thoracic

Vertebral

Inferior laryngeal

Ascendingcervical

Superficialcervical

Suprascapular

Deep cervical

Superior intercostal

Dorsal scapular

Costocervical trunk

Sup

Inf

R L

Subclavian arteryNote: (1) The superficial cervical artery is named ‘transverse cervical artery’ if it gives origin to the dorsalscapular artery instead of the latter arising separately from the second part of the subclavian artery; (2) phrenic branch of musculophrenic artery anastomoses with inferior phrenic artery

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SUBCLAVIAN ARTERYFrom: Right—brachiocephalic trunk

Left—aortic archTo: Axillary art

The subclavian arteries arise as indicatedabove and end at the outer border of the firstrib where they become the axillary arteries.They each have three parts: (1) medial (threebranches); (2) behind (two branches); and(3) lateral (no branches) to scalenus anterior.

Right subclavian artery—first part. Arisesfrom the brachiocephalic artery behind theright sternoclavicular joint, lying initiallyposterior to the right common carotid artery,then passing upwards and laterally to reachthe medial side of scalenus anterior. Anteriorto this first part are the vagus (X), its cardiacbranches, sympathetic nerves, the internaljugular and vertebral veins. The ansasubclavia (sympathetic nerves) curls aroundthe artery to lie both anterior and posteriorto it. As the artery arches laterally thesuprapleural membrane and the rightrecurrent laryngeal nerve lie inferior andposterior to it.

Left subclavian artery—first part. Arises fromthe arch of the aorta just posterior andslightly to the left of the origin of the leftcommon carotid artery at the level of theintervertebral disc of T3/T4. It passesupwards and then, behind the left sterno-clavicular joint, it arches laterally over thesuprapleural membrane to the medial edgeof scalenus anterior. Anterior to it in thethorax are the left common carotid artery,the left brachiocephalic vein, the left vagusand its cardiac branches and the left phrenicnerve. Posterior to it lie the left side of theoesophagus, the thoracic duct and longuscolli. Medial to it is the trachea, the leftrecurrent laryngeal nerve and, moresuperiorly, the thoracic duct. In the neck it is crossed anteriorly by the left phrenicnerve and the thoracic duct.

Subclavian artery—second part. Liesposterior to scalenus anterior and anterior to scalenus medius. Anterior to scalenusanterior are the phrenic nerve and, slightlyinferior, the subclavian vein. Postero-inferiorare the suprapleural membrane and thelower trunk of the brachial plexus. Superiorto it are the upper and middle trunks of thebrachial plexus.

Subclavian artery—third part. Begins at thelateral margin of scalenus anterior andextends to the outer (lateral) margin of thefirst rib where it becomes the axillary artery.Anterior to it is the external jugular vein and its tributaries. Antero-inferior is thesubclavian vein. Postero-inferior is the lowertrunk of the brachial plexus and the first rib.Posterosuperior are the upper and middletrunks of the brachial plexus.

Vertebral artery (see also internal carotid,vertebrobasilar system & circle of Willis, pp. 8–9). Arises from the posterosuperioraspect of the first part of the subclavianartery and ends where the arteries from thetwo sides join to form the basilar artery at thelower pons. It angles posteriorly between the medial border of scalenus anterior andthe lateral border of longus colli in the apexof the pyramidal space before entering theforamen in the transverse process of C6behind its anterior tubercle (carotid tubercleof Chassaignac). Lying anterior to this firstpart are the common carotid artery and thevertebral vein and, more medially, theinferior thyroid artery and middle cervicalganglion. On the left the thoracic ductcrosses it anteriorly. Posterior to it are theanterior primary rami of C7 and C8 nervesand more medially the inferior cervical(stellate) ganglion. The second part of the artery ascends within the foramina of the transverse processes of C6 to C1,accompanied by sympathetic nerves andvertebral veins. It passes out posteriorlybehind the lateral mass of the atlas before

ARTERIES Subclavian artery

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Subclavian artery ARTERIES

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Phrenic branch

Pericardiacophrenic


Scalenusanterior

Vagus nerve

Recurrent laryngealnerve

Thyrocervical trunk

Inferior thyroid

Superior epigastric

Musculophrenic

Internal thoracic

Vertebral

Inferior laryngeal

Ascendingcervical

Superficialcervical

Suprascapular

Deep cervical

Superior intercostal

Dorsal scapular

Costocervical trunk

Sup

Inf

R L

Subclavian arteryNote: (1) The superficial cervical artery is named ‘transverse cervical artery’ if it gives origin to thedorsal scapular artery instead of the latter arising separately from the second part of the subclavianartery; (2) phrenic branch of musculophrenic artery anastomoses with inferior phrenic artery

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turning medially over its posterior arch. It then turns anteriorly to pierce the atlanto-occipital membrane lateral to thecervicomedullary junction. It pierces thedura and arachnoid to ascend supero-medially around the anterior aspect of themedulla where it joins the artery from theopposite side at the lower border of the ponsto form the basilar artery. (Other branches,not illustrated, are spinal, meningeal andmuscular.)

Internal thoracic artery. Arises from theanterior aspect of the first part of thesubclavian artery and passes inferiorlybehind the brachiocephalic vein and thephrenic nerve to reach the dome of thepleura. It then angles medially to lieposterior to the upper six costal cartilages,between the internal intercostal andtransversus thoracis muscles. It terminates atthe 6th intercostal space to give the superior

epigastric and musculophrenic arteries.(Other branches, not illustrated, aremediastinal, thymic, sternal and perforating(mammary).)

Inferior thyroid artery. Ascends along themedial edge of scalenus anterior. Just belowthe anterior tubercle of C6 it turns mediallyto reach the lower thyroid gland, passingbetween vertebral artery and vein(posteriorly) and carotid sheath andsympathetic chain (anteriorly). Its terminalbranches are often amongst the recurrentlaryngeal nerve. (Other branches of inferiorthyroid artery, not illustrated, are glandular,pharyngeal, oesophageal and tracheal.)

Superior intercostal artery. Passes inferiorly,anterior to the necks of the first two ribs toprovide the posterior intercostal arteries forthe first two intercostal spaces.

ARTERIES Subclavian artery

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Axillary artery ARTERIES

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1

Pectoralisminor


Inferior borderof teres major

Posteriorcircumflexhumeral

Anteriorcircumflexhumeral

Superior thoracic

Thoracoacromial trunk

Lateral thoracic

Circumflex scapular

Thoracodorsal

Subscapular

Clavicular

Humeral

Acromial

Pectoral

branches

Sup

Inf

R L

Axillary artery

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AXILLARY ARTERYFrom: Subclavian artTo: Brachial art

This is the continuation of the subclavianartery. It commences at the lateral border ofthe 1st rib and ends at the inferior border ofteres major to become the brachial artery. It is divided into three parts by pectoralisminor. It is invested in a fascial sheath arising from the prevertebral fascia.

First part is medial to the upper border ofpectoralis minor and has one branch.Anterior to it is the clavipectoral fascia,subclavius and the lateral pectoral nerve.The axillary vein is medial whilst posteriorto it are the upper part of serratus anterior,the long thoracic nerve, the medial pectoralnerve and the medial cord of the brachialplexus. Lateral to it are the lateral andposterior cords of the brachial plexus.

Second part has pectoralis minor lyinganterior to it and has two branches. Medialto it is the axillary vein and medial cord of

the brachial plexus. Posterior to it are theposterior cord and subscapularis whilstlateral to it is the lateral cord of the brachialplexus.

Third part extends from the lower border ofpectoralis minor to the inferior border ofteres major and has three branches. Anteriorto it are pectoralis major, the clavipectoralfascia and the median nerve. Medial to it liethe axillary vein and the ulnar nerve.Posterior to it are the radial nerve, teresmajor, subscapularis and the tendon oflatissimus dorsi. On its lateral side lie themusculocutaneous nerve, lateral root (head)of the median nerve, the tendon of biceps inthe bicipital groove and coracobrachialis.

Posterior circumflex humeral artery. Passesposteriorly through the quadrangular spacewith the axillary nerve to supply shoulderjoint and surrounding muscles.

Note. Lateral thoracic artery and pectoralbranches of the thoraco-acromial trunk areimportant supply vessels for the breast.

ARTERIES Axillary artery

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Brachial artery ARTERIES

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1

Lower borderof teres major

Ulnar nerve

Median nerve

Humeral nutrient

Medial intermuscular septum

Lateralintermuscularseptum

Interosseous membrane

Profundabrachii

Superior ulnar collateral

Anterior ulnar recurrent

Posterior ulnar recurrent

Ulnar

Anteriorinterosseous

Posteriorinterosseous

Radial

Radialrecurrent

Interosseousrecurrent

Middlecollateral

Radialcollateral

Inferior ulnar collateral

Sup

Inf

R L

Brachial artery

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BRACHIAL ARTERYFrom: Axillary artTo: Radial & ulnar arts

This is the continuation of the axillary arterybeginning at the lower margin of the teresmajor and ending in the cubital fossa at thelevel of the neck of the radius as the radialand ulnar arteries. At first it lies medial to thehumerus then it spirals around to lie anteriorto it. It is superficial throughout its courseand accompanied by venae commitantes. It is crossed from lateral to medial by themedian nerve in the mid arm and by thebicipital aponeurosis in the cubital fossa.Medial to it is the ulnar nerve in the upper

arm and, distally, the median nerve. Lateralto it high up are the median and musculo-cutaneous nerves. Coracobrachialis, biceps and its tendon also lie on its lateralside. The artery lies first on the long and thenthe medial head of triceps, then brachialis in the lower third of the arm.

Arteria profunda brachii. Leaves theposteromedial aspect of the brachial arteryjust below teres major and passes posteriorlybetween the long and medial heads of tricepswith the radial nerve and into the radialgroove before breaking up into its terminalbranches.

ARTERIES Brachial artery

23

1

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Radial artery ARTERIES

24

1

Flexor retinaculum

First dorsalinterosseus

Adductorpollicis

Dorsal carpalbranch

Palmar carpalbranch

Superficial palmar branch

Deep palmar arch

Palmarmetacarpalbranches

Arteria princepspollicis

Arteria radialisindicis

Sup

Inf

R L

Brachioradialis

Radial artery

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RADIAL ARTERYFrom: Brachial art in midline of cubital fossaTo: Deep palmar arch in hand

The radial artery arises at the terminalbifurcation of the brachial artery in thecubital fossa at the level of the neck of theradius. It crosses anterior to the bicepstendon to lie initially on supinator. It thenpasses down the radial side of the forearmlying consecutively on pronator teres, theradial head of flexor digitorum superficialis,flexor pollicis longus and the insertion ofpronator quadratus before passing onto thelower end of the radius where its pulse ispalpable as it lies lateral to the tendon offlexor carpi radialis. It thus lies deep tobrachioradialis and, to a lesser extent, flexorcarpi radialis. The superficial branch of theradial nerve lies lateral to it in the forearm. It gives off a palmar carpal branch whichcontributes to the palmar carpal arch. It thengives off a superficial palmar branch (palmarcutaneous branch) which supplies the thenarmuscles before anastomosing with thesuperficial palmar arch. The radial artery

then passes beneath the tendons of abductorpollicis longus and extensor pollicis brevis toenter the anatomical snuff box. It passesacross the snuff box on the scaphoid andtrapezium and under the tendon of extensorpollicis longus. It gives off a dorsal carpalbranch to the dorsal carpal arch which inturn supplies the wrist joint, the dorsalaspects of the metacarpals and the dorsaldigital arteries. The radial artery then passesdown between the two heads of the firstdorsal interosseus and, before it enters thepalm of the hand, it gives off two namedvessels—arteria princeps pollicis (firstpalmar metacarpal artery) and arteriaradialis indicis. The continuation of theradial artery then passes between the twoheads of adductor pollicis to become thedeep palmar arch which lies 1cm proximalto the superficial palmar arch (ulnar artery).It supplies the palmar metacarpals, gives offa recurrent branch to the palmar carpal archand three perforating branches whichanastomose with the dorsal metacarpalarteries.

ARTERIES Radial artery

25

1

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Ulnar artery ARTERIES

26

1

Posteriorinterosseous

Pronatorteres

Interosseousmembrane

Flexor carpi ulnaris

Flexor retinaculumDorsal carpal branch

Deep branchPalmar digitalbranches

Superficialpalmar arch

Palmar carpal branch

Perforating branch

Commoninterosseous

Anterior interosseous

Muscularbranches

Interosseous membrane

Sup

Inf

R L

Ulnar artery

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ULNAR ARTERYFrom: Brachial artTo: Superficial palmar arch in hand

The artery arises as the terminal bifurcationof the brachial artery in the cubital fossa atthe level of the neck of the radius. It leavesthe fossa deep to the deep head of pronatorteres and deep to the fibrous arch of flexordigitorum superficialis just lateral to themedian nerve to cross beneath the nervebefore running down the ulnar side of theforearm. It lies on flexor digitorumprofundus with the ulnar nerve on its medialside. It lies lateral to flexor carpi ulnarisbefore passing superficial to the flexorretinaculum. The dorsal and palmar carpalarteries contribute, with similarly namedarteries from the radial artery, to the dorsaland palmar carpal arches. The ulnar arterythen gives off a deep branch to the deeppalmar arch before forming the superficialpalmar arch at the level of the distal borderof the extended thumb. The superficial archsupplies the hypothenar eminence and givesoff the palmar digital arteries. At the level ofpronator teres the ulnar artery gives off thecommon interosseous artery which divides

into anterior and posterior interosseousarteries.

Anterior interosseous artery. Descends onthe anterior surface of the interosseousmembrane together with the anteriorinterosseous branch of the median nervelying between flexor digitorum profundusmedially and flexor pollicis longus laterally.Branches perforate the membrane to supplythe extensor muscles. Above pronatorquadratus it gives off a small branch whichdescends deep to the muscle to join thepalmar carpal arch, then the anteriorinterosseous artery itself passes posteriorlythrough the membrane to anastomose withthe posterior interosseous artery whichdescends to join the dorsal carpal arch.

Posterior interosseous artery. Passesposteriorly above the interosseousmembrane and then runs between supinatorsuperficially and abductor pollicis longusdeeply with the deep branch of the radialnerve (posterior interosseous nerve) todescend to supply the extensor muscles ofthe forearm. It anastomoses with the distalbranches of the anterior interosseous arteryand dorsal carpal arch.

ARTERIES Ulnar artery

27

1

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Thoracic (descending) aorta ARTERIES

28

1

Subcostal

LeftbronchialOesophageal

Right bronchial

Mediastinal

Median arcuate ligament

Posteriorintercostal3-11

Sup

Inf

R L

Thoracic (descending) aorta

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THORACIC (DESCENDING) AORTAFrom: Arch of aortaTo: Abdominal aorta

This arises as the continuation of the arch ofthe aorta commencing to the left of the bodyof T4 and ends as it passes into the abdomenat T12. It grooves the left side of the bodiesof T4–T6 vertebrae then it inclines mediallyto lie in the midline over the lower thoracicvertebrae. It passes out of the thorax at T12posterior to the median arcuate ligament ofthe diaphragm to become the abdominalaorta. Lying anterior to it from above down

are the hilum of the left lung (particularly the left main bronchus), pericardium, left atrium, oesophagus and diaphragm.Posterior lie the necks of the ribs of T5–T6and the sympathetic chain at that level, thevertebral bodies and hemiazygos veins. Toits right lie the right pleura and lung andthoracic duct. The oesophagus and itssurrounding plexus of nerves is initially to itsright but lower down it crosses the aorta tolie anterior then slightly to the left. To its leftare the left pleura and lung. (Other branch,not illustrated, is pericardial.)

ARTERIES Thoracic (descending) aorta

29

1

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Abdominal aorta ARTERIES External iliac artery

30

1

Deepinguinalring

from anteriorbranch

Inguinalligament

Coeliactrunk

Superiormesenteric

Inferiormesenteric

CommoniliacInferior

epigastric

Deepcircumflexiliac

Cremasteric

External iliac

Internal iliac

Median sacral

GonadalSpinalbranches

Lumbar

Pubic branch

Phrenic branch

Suprarenal branch

SuprarenalSuprarenal branch

ApicalUpperPosterior branch

Lower

Uretericbranches

Middle from anteriorbranch

Renalartery

Inferiorphrenic

Sup

Inf

R L

Abdominal aorta & external iliac artery

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ABDOMINAL AORTAFrom: Thoracic aortaTo: Common iliac arts

This main artery arises as the continuation ofthe thoracic aorta as it passes, in the midline,posterior to the median arcuate ligament ofthe diaphragm at T12 and it ends slightly to the left of the midline at L4 where itterminates as the left and right common iliac arteries. Anterior to it, from abovedownwards, are the coeliac trunk and itsbranches, the coeliac plexus, lesser sac,superior mesenteric artery, left renal vein,body of pancreas, commencement of each gonadal artery, fourth part of theduodenum, posterior parietal peritoneum,attachment of the mesentery and inferiormesenteric artery. Posterior to it are thelumbar arteries and left lumbar veins,anterior longitudinal ligament and vertebralbodies with their intervertebral discs. To itsright are the cisterna chyli, thoracic duct,azygos vein, right crus of diaphragm andinferior vena cava. To its left are the left crus of diaphragm, left coeliac ganglion, the duodenojejunal flexure (upper border of L2), sympathetic trunk and inferiormesenteric vessels. On both sides thephrenic, suprarenal and renal vessels arelateral whilst distal to the bifurcation of theabdominal aorta is the median sacral artery.

Common iliac arteries. These commence atthe bifurcation of the abdominal aorta justto the left of the midline at L4 and passinferolaterally to the level between L5 and S1 vertebrae where they bifurcate anterior tothe sacro-iliac joint to give the external and

internal iliac arteries. Anterior to each vesselare sympathetic contributions to the superiorhypogastric plexus, the ureter (near theterminal bifurcation of the vessel),peritoneum and small bowel. In addition on the left side the superior rectal artery lies anterior. Posterior to each vessel are the sympathetic trunk, obturator nerve,lumbosacral trunk, iliolumbar artery and thebodies of L4 and L5 with the disc betweenthem. In addition posteriorly on the rightside are the terminal portions of the commoniliac veins and the commencement of theinferior vena cava. The left common iliacvein lies posteromedial to the left commoniliac artery. Psoas major lies lateral to eachvessel.

Gonadal artery. Descends passing obliquelyinferiorly on the posterior abdominal wall to the level of the external iliac artery. Thetesticular arteries pass around the lowerborder of the false pelvis to enter the inguinalcanal through the deep ring to form part ofthe spermatic cord. The ovarian vesselsdescend over the external iliac vessels intothe infundibulopelvic fold to supply theovary via the broad ligament. The commonrelations of the arteries in both sexes are: left, posterior—psoas, genitofemoral nerve,ureter and external iliac artery; left,anterior—inferior mesenteric vein, left colic artery and sigmoid mesentery; right,posterior—inferior vena cava, psoas,genitofemoral nerve, ureter and external iliac artery; right, anterior—third part of the duodenum, right colic artery and ilealmesentery.

Abdominal aorta ARTERIES External iliac artery

31

1

EXTERNAL ILIAC ARTERYFrom: Common iliac artTo: Femoral art

The external iliac artery descends laterallyfrom the common iliac artery to pass underthe inguinal ligament at the mid inguinalpoint (half way between the anteriorsuperior iliac spine and symphysis pubis)where it becomes the femoral artery.

Posterior and lateral to it is the medialborder of psoas major whilst the femoralvein comes to lie medially. Anteromedially itis covered by peritoneum on which lies smallbowel with sigmoid colon additionally onthe left. It is crossed at its origin by the ureterand then by the gonadal vessels, genitalbranch of the genitofemoral nerve, deepcircumflex iliac vein and vas deferens orround ligament.

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Coeliac trunk ARTERIES

32

1Left branchof hepatic

Right branchof hepatic

Posteriorbranch

Anteriorbranch

Splenicbranches

Short gastricbranches

Oesophagealbranches

Commonhepatic

Leftgastric

Splenic

ArteriapancreaticamagnaRight

gastric

Cystic

Hepatic

Gastroduodenal

Superiorpancreatico-duodenal

Rightgastroepiploic

Leftgastroepiploic

Sup

Inf

R L

Coeliac trunk

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COELIAC TRUNKFrom: Abdominal aorta at lower border of

T12To: Terminal brs—left gastric, splenic &

common hepatic arts

The coeliac trunk (axis) arises from theanterior aspect of the abdominal aorta at thelevel of the lower border of T12 and after 1cm divides into its three terminal branches.

Left gastric artery. Passes superolaterally on the posterior wall of the lesser sac toreach the apex of this structure at the cardio-oesophageal junction where it divides into oesophageal branches to supplythe lower third of the oesophagus throughthe oesophageal opening in the diaphragm.Its terminal gastric branches run inferiorlyalong the upper portion of the lesser curve of the stomach to anastomose with the rightgastric artery.

Splenic artery. Passes laterally to the left,angled slightly superiorly, running in theposterior wall of the lesser sac. Its course is markedly tortuous as it runs along thesuperior border of the pancreas, passinganterior to the left crus of the diaphragm, the upper pole of the left kidney and the left suprarenal gland before entering the

lienorenal ligament to reach the splenichilum.

Common hepatic artery. Runsinferolaterally to the right in the posteriorwall of the lesser sac towards the first part of the duodenum where it gives off first thegastroduodenal and then right gastricarteries. It then curves anteriorly as thehepatic artery to pass into the peritonealreflection which forms the inferior margin ofthe opening of the lesser sac. It approachesthe portal vein from its left side and thencomes to lie anterior to it, with the bile ducton its right, as it ascends in the free border ofthe lesser omentum (anterior margin of theforamen of Winslow or epiploic foramen)before terminating at the porta hepatis as theright and left hepatic branches.

Gastroduodenal artery. Descends directlybehind the first part of the duodenum to theleft of the bile duct and divides at the upperborder of the pancreas into terminalbranches.

Right gastric artery. Arises from the hepaticartery as it enters the lesser omentum andpasses along the lesser curve of the stomachto anastomose with the left gastric artery.

ARTERIES Coeliac trunk

33

1

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Superior mesenteric artery ARTERIES Inferior mesenteric artery

34

1

Ileal

Inferiorpancreaticoduodenal

Middle colic

Rightcolic

Ascending colic

Anteriorcaecal

Posteriorcaecal Appendicular

Ileocolic

Ileal

Jejunal

Anterior andposteriorbranches

Sup

Inf

R L

Superiorrectal

Leftcolic

Superiorbranch

Inferiorbranch

Lower left colic

Sigmoid

Sup

Inf

R L

Inferior mesenteric artery

Superior mesenteric artery

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SUPERIOR MESENTERIC ARTERYFrom: Abdominal aortaTo: Terminal brs

The superior mesenteric artery arises fromthe anterior surface of the abdominal aortaat the level of L1. It passes inferiorly over theleft renal vein with the splenic vein and bodyof pancreas anterior to it. It next lies on theuncinate process of the pancreas and thejunction of the third and fourth parts of theduodenum from where it passes obliquelyand to the right into the mesentery of thesmall bowel before giving off its terminalbranches. The superior mesenteric vein is on its right whilst posterior to the terminalbranches are the inferior vena cava, the right ureter and psoas major. The superiormesenteric plexus of nerves surrounds theartery. It supplies bowel from the mid secondpart of the duodenum, jejunum, ileum,ascending and right two-thirds of transversecolon.

Inferior pancreaticoduodenal artery. Leavesthe superior mesenteric artery as it begins tocross the duodenum and divides into ananterior and posterior branch. The anteriorbranch passes to the right to anastomosewith the anterior superior pancreatico-duodenal artery anterior to the head of thepancreas. The posterior branch passes alsoto the right but posterior to the head of thepancreas to anastomose with the posteriorsuperior pancreaticoduodenal artery.

Middle colic artery. Note that this arteryarises early from the superior mesentericartery to supply the transverse colon. This islogical as the right colic would otherwiseneed to be excessively long.

Ileocolic artery. Passes obliquely inferiorly tothe right in the root of the mesentery where itpasses anterior to the right ureter and rightgonadal vessels to reach the caecum where itdivides into its terminal branches.

Superior mesenteric artery ARTERIES Inferior mesenteric artery

35

1

INFERIOR MESENTERIC ARTERYFrom: Abdominal aortaTo: Terminal brs

This artery arises from the anterior surfaceof the abdominal aorta at the level of L3posterior to the third and fourth part of theduodenum. It passes inferiorly and to the left

crossing the left common iliac artery medialto the left ureter. The inferior mesenteric vein lies on its left (lateral) side. It dividesinto its terminal branches in the descendingmesocolon. It supplies the left third of thetransverse colon, the descending and sigmoidcolon and the rectum to the dentate line ofthe anus.

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Internal iliac artery ARTERIES Femoral artery

1

Internal pudendal

Lateral sacral

Middle rectal

Lumbar

Iliac

SuperficialbranchDeep branch

MuscularAnastomoticCoccygealArteria comitansnervi ischiadici

Inferior rectal

Deep artery of penis

Dorsal artery of penisUrethral

Artery tobulb

Perineal

Uterine

Vaginal

Ureteric

Artery toligamentumteresPosterior branchAnterior branch

Vasal

Obliteratedumbilical

VesicalUreteric Greater sciatic foramen

VesicalUreteric

Ischialspine

Lessersciaticforamen

Obturatorforamen

Uterine

Posteriordivision

Anteriordivision

Inferiorgluteal

Superiorgluteal

Iliolumbar

Obturator

Superior vesical

Inferior vesical

Sup

Inf

R L

Superficialcircumflexiliac

Superficial epigastric

Superficial external pudendalDeep external pudendal

Medialcircumflexfemoral

Profundafemoris

Lateralcircumflexfemoral

Lower limit of femoral sheath

Femoralnerve

Adductorlongus

Adductor canal

Hiatus in adductor magnus

Ascending branch

Transverse branchDescending branch

Transversebranch

4 perforatingbranches

Descendinggenicularbranch

Muscular branches

Ascendingbranch

Sup

Inf

R L

Femoral artery

Internal iliac artery

36

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INTERNAL ILIAC ARTERYFrom: Common iliac artTo: Terminal brs

The artery commences at the level of the discbetween L5 and S1 and passes posteriorlyinto the pelvis for 4cm before forminganterior and posterior divisions which breakup into their terminal branches. Anterior liethe ureter and fallopian tube and ovary in thefemale. Posterior are the internal iliac vein,lumbosacral trunk and sacro-iliac joint. Onthe lateral side are the external iliac arteryand vein, obturator nerve and psoas major.The parietal peritoneum and small bowel liemedially.

Internal pudendal artery. Arises from theanterior division of the internal iliac arteryand descends on the lateral wall of the pelvistowards the greater sciatic foramen. It leaves

the pelvis via this foramen, inferior topiriformis, before passing over the tip of theischial spine to enter the ischio-anal fossa via the lesser sciatic foramen. In runs on the lateral wall of the ischio-anal fossa on obturator internus in the pudendal(Alcock’s) canal. It passes into the deepperineal pouch where it gives off its terminalbranches. (Other branches of the perinealbranch, not illustrated, are transverseperineal and posterior scrotal.)

Note: In the female the vaginal artery isequivalent to the inferior vesical artery in themale, and the uterine artery is equivalent tothe middle rectal artery. The round ligamentis supplied by the uterine artery whilst thevas deferens is usually supplied by theinferior vesical or less often by the superiorvesical artery.

Internal iliac artery ARTERIES Femoral artery

37

1

FEMORAL ARTERYFrom: External iliac artTo: Popliteal art

This is the continuation of the external iliacartery and commences posterior to theinguinal ligament at the mid-inguinal point(half way between the anterior superior iliacspine and the symphysis pubis). It ends as it passes through the adductor hiatus inadductor magnus to become the poplitealartery. It emerges from under the inguinalligament with the femoral vein medial to it,both within the femoral sheath. Lateral to itand outside the femoral sheath is the femoralnerve. It lies on the tendon of psoas majorand is separated from pectineus andadductor longus by the femoral vein whichcomes to lie progressively more posterior to

the artery within the femoral triangle. As thefemoral artery enters the adductor canal itlies on adductor longus then adductormagnus. It is covered initially only by deepfascia then by sartorius; the saphenous nervepasses anteriorly from lateral to medial.Anterolateral to the artery is vastus medialis.

Profunda femoris is the main branch of the femoral artery which is given offposterolaterally just below the femoralsheath 3.5cm below the inguinal ligament. It runs posteriorly between pectineus andadductor longus to pass into the deep thighwhere it provides the deep structures and theposterior and medial compartments withtheir main arterial supply. Perforating anddescending branches anastomose with thegenicular branches of the popliteal artery.

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1Hiatus in adductor magnus

Tibial nerve

Soleal arch Deep fascia

Muscularbranches

Superiormedialgenicular

Middlegenicular

Inferiormedialgenicular

Posteriortibial Fibular (peroneal)

Anteriortibial Sural

Inferiorlateralgenicular

Superiorlateralgenicular

Sup

Inf

L R

Anteriorandposteriortibialrecurrent


Muscularbranches

Dorsal metatarsalbranches

1st dorsalmetatarsal

Tibialis anteriorExtensor digitorumlongus

Extensor hallucislongus

Extensorretinaculum

Deep peroneal nerve

Anteriorlateralmalleolar

Lateraltarsal

Medial tarsal

Deep plantarArcuate

Anteriormedial malleolar

Dorsalis pedis

Sup

Inf

R L

Anterior tibial arteryNote: viewed from in front

Popliteal arteryNote: viewed from behind

Popliteal artery ARTERIES Anterior tibial artery

38

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POPLITEAL ARTERYFrom: Femoral artTo: Ant & post tibial arts

This artery commences as the continuationof the femoral artery as the latter passesthrough the hiatus in adductor magnus andends as it passes under the fibrous arch ofsoleus where it immediately divides intoanterior and posterior tibial arteries. Thepopliteal artery extends from a hand’sbreadth above the knee and to the same

distance below it. It enters the popliteal fossamedial to the femur and becomes the deepeststructure, lying with only fat between it andthe popliteal surface of the femur. Lowerdown it lies on the capsule of the knee jointand then on popliteus. Biceps femoris islateral to it and semimembranosus medial.Lower down it lies between the two heads of gastrocnemius. It is crossed laterally tomedially by the tibial nerve and the poplitealvein with the vein always between the arteryand nerve.

Popliteal artery ARTERIES Anterior tibial artery

39

1

ANTERIOR TIBIAL ARTERYFrom: Popliteal artTo: Dorsalis pedis art

This artery commences at the bifurcation ofthe popliteal artery just under the fibrousarch of soleus, at the distal border ofpopliteus. It supplies the structures in theextensor compartment of the lower leg. Itpasses anteriorly between the heads oftibialis posterior to pass above the upperborder of the interosseous membrane,medial to the neck of the fibula accompaniedby its venae commitantes. It descends on theinterosseous membrane and crosses thelower tibia at the ankle joint, mid way

between the malleoli and there becomes thedorsalis pedis artery. Initially it lies betweentibialis anterior (medially) and extensordigitorum longus (laterally), then betweentibialis anterior and extensor hallucis longus.At the ankle it is crossed anteriorly by theextensor retinacula and also from lateral tomedial by the tendon of extensor hallucislongus. The deep fibular (peroneal) nerve isinitially lateral to the artery high up in theextensor compartment but passes anterior to it half way down the leg, becoming lateralto it again under the extensor retinaculum.The anterior tibial veins run in closeassociation with the artery throughout.

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Posterior tibial artery ARTERIES

40

1Circumflexfibular(peroneal)

Soleus

Tibialnutrient

Fibular (peroneal)

Medial plantarLateralplantar

Muscular

Posterior medialmalleolar branches

Calcanealbranches

Superficialdigital branches

Plantarmetatarsal

Lateral plantar

Tibial nerve

Flexor retinaculum

Flexor hallucis longus

Flexor digitorumlongus

Tibialis posterior

Sup

Inf

L R

Medial malleolus

Posterior tibial arteryNote: viewed from behind

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POSTERIOR TIBIAL ARTERYFrom: Popliteal artTo: Med & lat plantar arts

This artery arises at the bifurcation of thepopliteal artery just under the fibrous arch ofsoleus, at the lower border of popliteus, andends by bifurcating into the medial andlateral plantar arteries deep to abductorhallucis. It supplies structures in theposterior compartment of the lower leg. It isaccompanied by venae commitantes and lies

from above downwards on tibialis posterior,flexor digitorum longus, the tibia and theankle joint. It lies deep to gastrocnemius,soleus, the flexor retinaculum and abductorhallucis. Posterior to the medial malleolus itlies between the tendon of flexor digitorumlongus and the tibial nerve which crossesposterior to the artery mid way down the calf from the medial side to become postero-lateral. (Other branch, notillustrated, is a communicating branch to the fibular (peroneal) artery.)

ARTERIES Posterior tibial artery

41

1

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Fibular (peroneal) artery ARTERIES

42

1


Superiorperoneal (fibular)retinaculum

Soleus

Fibularnutrient

Muscular

Calcaneal

Perforating

Sup

Inf

L R

Fibular (peroneal) artery

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FIBULAR (PERONEAL) ARTERYFrom: Post tibial artTo: Terminal brs

This is a branch of the posterior tibial artery arising 2.5cm below its origin undersoleus. It supplies structures in the lateralcompartment of the lower leg. Due to theproximity of origin of the three terminalbranches of the popliteal artery this point of origin is commonly referred to as the‘popliteal trifurcation’. It passesinferolaterally to reach and run along the

medial crest of the fibula between tibialisposterior and flexor hallucis longus to divideinto its terminal branches at the level of theinferior tibiofibular joint and the superiorfibular (peroneal) retinaculum. Thus,although it supplies the fibular (peroneal)compartment by branches that pass laterally, the main fibular (peroneal) artery itself remains in the posteriorcompartment. Above, it is covered by soleus and deep fascia whilst in the lower leg flexor hallucis longus crosses it fromlateral to medial.

ARTERIES Fibular (peroneal) artery

43

1

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Scapular anastomoses ARTERIES

44

1Branches ofsuperficial cervical

Subclavian

Cut endof clavicle

Dorsalscapular

1st rib

Posterior brsof intercostals

Subscapular

Circumflexscapular

Medial &lateralcircumflexhumeral

Lateralthoracic

Suprascapular

Arterial anastomoses around scapulaNote: The superficial cervical artery is named “transverse cervical artery” if it gives origin to the dorsalscapular artery instead of the latter arising separately from the second part of the subclavian artery

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ARTERIES Scapular anastomoses

45

1Descending br of inf gluteal

Post br ofobturator

Transverse brsof med and latcircumflexfemorals

Ascending br offirst perforating

Trochanteric

Cruciate

Ascending br ofmed circumflexfemoral

Ascending br oflat circumflexfemoral

Inf gluteal

Sup gluteal

Arterial anastomoses around hip

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NOTES

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1

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1: arteries 1 - wiley...1 1 coronary arteries 2 ascending & arch of aorta 4 internal carotid...

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