l8 circulation arteries

Blood Vessels of the Systemic Circulation: Arteries

Dr. Sam Nang

INTERNATIONAL UNIVERSITY

Blood Vessels of the Systemic Circulation: Arteries

The systemic circulation is the flow of blood through the system of blood vessels that carry blood from the left ventricle of the heart to the tissues of the body and back to the right atrium.

Oxygenated blood from the pulmonary veins passes from the left atrium into the left ventricle and from the left ventricle into the aorta. Blood is distributed from the aorta to all portions of the body.

All arteries of the systemic circulation branch directly or indirectly from the aorta. The aorta is usually considered in three parts: the ascending aorta, the aortic arch, and the descending aorta. The descending aorta is further divided into the thoracic aorta and the abdominal aorta.

The part of the aorta that passes superiorly from the left ventricle is called the ascending aorta. The right and left coronary arteries arise from the base of the ascending aorta and supply blood to the cardiac muscle.

The aorta arches posteriorly and to the left as the aortic arch. Three major arteries, which carry blood to the head and upper limbs, originate from the aortic arch. They are the brachiocephalic artery, the left common carotid artery, and the left subclavian an artery.

The descending aorta is the longest part of the aorta. It extends through the thorax and abdomen to the upper margin of the pelvis. The part of the descending aorta that extends through the thorax to the diaphragm is called the thoracic aorta.

The part of the descending aorta that extends from the diaphragm to the point at which it divides into the two common iliac arteries is called abdominal aorta.

Arteries of the Head and Neck

The first vessel to branch from the aortic arch is the brachiocephalic artery.

It is a short artery, and it branches at the level of the clavicle to form the right common carotid artery, which transports blood to the right side of the head and neck, and the right subclavian artery, which transports blood to the right upper limb.

There is no brachiocephalic artery on the left side of the body. Instead, the left common carotid and left subclavian artery branch directly off the aortic arch.

They are the second and third branches of the aortic arch.The left common carotid artery transports blood to the left side of the head and neck, and the left subclavian artery transports blood to the left upper limb.

The common carotid arteries extend superiorly along each side of the neck to the angle of the mandible, where they branch into internal and external carotid arteries. The base of each internal carotid artery is slightly dilated to form a carotid sinus, which contains structures important in monitoring blood pressure (baroreceptors).

the external carotid arteries have several branches that supply the structures of the neck, face, nose, and mouth. The internal carotid arteries pass through the carotid canals and supply most of the blood to the brain.

Some of the blood to the brain is supplied by the vertebral arteries, which branch from the subclavian arteries and pass to the head through the transverse foramina of the cervical vertebrae.

The vertebral arteries then pass into the cranial vault through the foramen magnum. Branches of the vertebral arteries supply blood to the spinal cord, as well as to the vertebrae, muscles, and ligaments in the neck.

Within the cranial vault the vertebral arteries unite to form a single basilar artery located along the anterior, inferior surface of the brainstem. The basilar artery gives off branches that supply blood to the pons, cerebellum, and midbrain.

It also forms right and left branches that connect with the right and left internal carotid arteries. These blood vessels form a system of vessels called the cerebral arterial circle or the circle of Willis at the base of the brain. The vessels that supply blood to most of the brain branch off of the cerebral arterial circle

Most of the blood supply to the brain is through the internal carotid arteries; however, not enough blood is supplied to the brain to maintain life if either the carotid arteries or the vertebral arteries are blocked.

ARTERIES OF THE BRAIN• ANTERIORR CIRCULATION

I. Introduction: the anterior part of the brain receives its blood from the internal carotid aa. (80% of total cerebral flow); the vertebral-basilar system (20% total blood flow) supplies the brain stem, cerebellum, and parts of the temporal and occipital lobes.

Anatomic connections exist between vessels of the 2 systems at the circle of Willis, but functionally, the systems are almost completely separate.

Cerebral arteries. Are considered to be end arteries since large anastomoses are not found between large branches of the circle of Willis. The capillary network of the cortex is dense, and neurons rarely are more than 50 um from a capillary

II.Circle of Willis: a ring of vessels beneath the hypothalamus, enclosing the lamina terminalis, optic chiasm, infundibulum, tuber cinereum, mamillary bodies, and posterior perforated substance.

It is composed of a single ant. Communicating artery. and the paired anterior Cerebral, internal carotid, posterior Communicating, and posterior. Cerebral arteries

III. Anterior circulationA. INTERAL CAROTID enters skull

through carotid canal in petrous temporal bone, passes along carotid groove, and exits anteriorly near apex of petrous bone to enter the posterior part of foramen lacerum in which it ascends to a juxtasellar location by piercing the dural layers of the cavernous sinus.

It has an S-shaped course in the sinus, called the carotid siphon. As it pierces the dura, it gives off its 1st branch, the ophthalmic artery., then posterior Communicating artery., and then the anterior choroidal artery. The artery then bifurcates into anterior. And middle cerebral arteries.

1. Anterior cerebral: smaller of 2 terminal branchs.; runs horizontal and anteromedial between optic nerve. and anterior Perforated substance to enter interhemispheric (longitudinal) fissure at midline, anastomosing, via the ant. Communicating artery., with its counterpart of the opposite side. Major branches are:

a. Prior to anterior Communicating artery: inferior branchs. To optic nerve. and chiasm, superior branchs. (via anterior Perforating substance) to basal ganglia, internal capsule, and anterior Hypothalamus. The largest branch is the recurrent artery of Huebner to the head of the caudate nucleus and anterior Limb of the internal capsule

b. Beyond the anterior Communicating artery (interhemispheric): anterior Carotid ascends in cistern of lamina terminalis and around genu of corpus callosum, giving rise to:

i. Medial orbitofrontal artery: to orbital gyrus and olfactory tract and bulb

ii. Frontopolar artery: to undersurface of frontal lobe and midline structures

iii. Near genu of corpus callosum, anterior Cerebral divides into a callosomarginal artery. (runs in cingulated sulcus) and a pericallosal artery. (runs above corpus callosum). They supply the medial and dorsal surfaces of frontal and parietal lobes, including the medial part of the motor and somatosensory cortex

2. Middle cerebral: largest branch; runs along lateral (sylvian) fissure. Cortical areas supplied are insula, claustrum, lateral part of hemisphere (except for superior convexity from frontal to occipital pole), and inferior convexity from occipital to temporal pole.

It gives off 2 groups of ganglionic branches (3-6 medial and 3-6 lateral striate arteries. Which enter brain through anterior Perforated substance to internal capsule, basal ganglia, and thalamus); a lateral orbitofrontal artery.

( to lateral orbital and inferior frontal gyri); and cortical branchs. (to lateral surface of frontal, parietal, and temporal lobes, including premotor, motor and somatosensory cortices of cerebral convexities). The largest striate branches are:

a.Medial lenticulostriates: to outer segment of the globus pallidus

b. Lateral lenticulostriates: to putamen, superior ½ of internal capsule and adjacent corona radiate, and much of the caudate nucleus

3. Posterior communicating: runs posteriorly to join posterior cerebral artery of basilar artery Branches supply: optic tract and chiasm, hypothalamus, cerebral peduncle, thalamus, subthalamus, interpeduncular area, and hippocampla gyrus

4. Anterior choroidal: passes along optic tract and around cerebral peduncle to enter temporal horn of lateral ventricle to end in glomus of choroids plexus of ventriclea. Branches supply: optic tract, hippocampus, caudate nucleus, internal capsule, cerebral peduncles, thalamus, and part of the midbrain

ARTERIES OF THE BRAIN:• POSTERIOR CIRCULATION

I. Introduction of vertebral-basilar system: the vertebral arteries Pass up neck through foramina in transverse processes of cervical vertebrae 6 to 1. after looping between atlas and occipital bone, they penetrate the atlanto-occipital membrane and dura and enter skull through foramen magnum.

The left Vertebral is usually larger than the right. The 2 vertebrals merge at the pontomedullary junction of form the basilar artery. which passes in the midline ventral sulcus of the pons to end just posterior to the posterior to the posterior clinoid process. This system supplies the posterior cerebrum, midbrain, pons, medulla, and cerebellum

II.Vertebral arteries: branches areA. ANTERIOR SPINAL (single) descends on cord anteriorly in

anterior Median sulcus to supply ventral funiculi, ventral horns, and

base of doral horns

B. POSTERIOR SPINAL (paired) descend on cord posteriorly, associated with doral nerve roots, and supply doral funiculi and doral hornsC. POSTERIOR INFERIOR CEREBELLAR (largest branch): to choroids plexus of 4th ventricle, lateral medulla, inferior cerebellar peduncle, and part of cerebellum

III. Basilar artery terminates in the interpeduncular (crural) cistern where it divides into the right. And Ieft. Cerebral arteries Just superior to the oculomotor nerves. Branches:

A. PONTINE: numerous, small, penetrating to pons and ventrolateral cerebellar cortex and inferior part of the midbrain

B. INTERNAL AUDITORY (labyrinthine) passes with CN VII and VIII to internal auditory meatus and supplies dura of canal, cochlea, labyrinth, and facial nerveC. ANTERIOR INFERIOR CEREBELLAR: to brain stem and superior and middle cerebellar peduncles and anterior part of undersurface of cerebellar hemisphere

D. SUPERIOR CERBELLAR: medial branches to mesencephalon, pons, medial cerebellum, and deep cerebellar nuclei; lateral branches to anterolateral part of superior ½ of cerebellar cortex, superior and middle cerebellar peduncles, dentate nerve, and roof nuclei.

In addition, the more medial superior vermian branch. (anastomosis with inferior vermian branch of posterior, inferior Cerebellar) supplies the inferior colliculi, superior cerebellar peduncles, and dentate nerve.

E. POSTERIOR CEREBRAL passes around midbrain in cisterna ambiens, then through incisura of tentorium, along medial surface of temporal and occipital lobes to end in the calcarine fissure to supply the visual cortex. Branches to:

1. Posteromedial ganglionic: posterior Hypothalamus, pasts of thalamus and midbrain, and the medial choroidal artery to choroids plexus of the 3rd ventricle

2. Posterior choroidal branches: to posterior thalamus, subthalamus, internal capsule and choroids plexus of 3rd ventricle, and body of lateral ventricle3. Cortical branches: to inferior surface of temporal and occipital lobes

Arteries of the Upper Limbs

The arteries of the upper limbs are named differently as they pass into different body regions, even though no major branching occurs. The subclavian artery, located deep to the clavicle, becomes the axillary artery, in the axilla (armpit). The brachial artery, located in the arm, is a continuation of the axillary artery.

• Branches of AXILLARY:

- superior thoracic artery

- thoracoacromial artery

- lateral thoracic artery

- subscapular artery

- scapular circumflex artery

- dorsal scapular artery

- posterior humeral circumflex artery

- anterior humeral circumflex artery

Blood pressure measurements are normally taken from the brachial artery. The brachial artery branches at the elbow to form the ulnar artery and the radial artery, which supply blood to the forearm and hand.

•Branches of Brachial Artery:

- superior ulnar collateral arterry

- inferior ulnar collateral arterry

•Branches of Deep Brachial Artery:

-radial collateral arterry

-middle collateral artery

The radial artery is the artery most commonly used for taking a pulse. The pulse can be detected conveniently on the thumb (radial) side of the anterior surface of the wrist.

• Branches of Radial Artery:- radial recurrent artery

- princeps pollicis artery

- radial of index finger artery

- dorsal carpal artery

- dorsal carpal network

- dorsal metacarpal arteries

-dorsal digital arteries

-superficial palmar artery

• Branches of Ulnar Artery:

- anterior ulnar recurrent artery

- posterior ulnar recurrent artery

- common interosseous artery

- interosseous recurrent artery

- anterior interosseous artery

- posterior interosseous artery

-volar interosseous artery

- common palmar digital arteries

-Proper palmar digital arteries- deep palmar (arterial) arch

- superficial palmar (arterial) arch

The Thoracic Aorta and Its Branches

The branch of the thoracic aorta can be divided into two groups: the visceral arteries supply the thoracic organs, and the parietal arteries supply the thoracic wall. The visceral branches of the thoracic aorta supply the esophagus (Esophageal artery), trachea, parietal pericardium (Pericardial artery), and part of the lung (Bronchial artery).

The major parietal arteries are the posterior intercostal arteries, which arise from the thoracic aorta and extend between the ribs. They supply intercostal muscle, the vertebrae, the spinal cord, and deep muscles of the back. The superior phrenic arteries supply the diaphragm.

Bronchial Artery

Esophageal Artery

The internal thoracic arteries are branch of the subclavian arteries. They descend along the internal surface of the anterior thoracic wall and give rise to branches called the anterior intercostal arteries, which extend between the ribs to supply the anterior chest wall.

The Abdominal Aorta and Its Branches

The branches of the abdominal aorta, like those of the thoracic aorta, can he divided into visceral and parietal groups. The visceral arteries are divided into paired and unpaired branches. There are three major unpaired branches: the celiac trunk, superior mesenteric artery, and the inferior mesenteric artery.

The celiac trunk supplies blood to the stomach, pancreas, spleen, upper duodenum, and liver. The superior mesenteric artery supplies blood to the small intestine and the upper portion of the colon, and the inferior mesenteric artery supplies blood to the remainder of the colon.

There are three paired visceral branches of the abdominal aorta. The renal arteries supply the kidneys and the suprarenal arteries supply the adrenal glands. The testicular arteries supply the testes in males or the ovarian arteries supply the ovary in females.

The parietal branches of the abdominal aorta supply the diaphragm and abdominal wall. The inferior phrenic arteries supply the diaphragm, the lumbar arteries supply the lumbar vertebrae and back muscles, and the median sacral artery Supplies the inferior vertebrae.

Arteries of the Pelvis

The abdominal aorta divides at the level of the fifth lumbar vertebra into two common iliac arteries. Each common iliac artery divides to form an external iliac artery, which enters a lower limb, and an internal iliac artery, which supplies the pelvic area.

Visceral branches of the internal iliac artery supply organs such as the urinary bladder, rectum, uterus, and vagina. Parietal branches supply blood to the walls and floor of the pelvis; the lumbar, gluteal, and proximal thigh muscles; and the external genitalia.

Arteries of the lower limpsLike the arteries of the upper limbs, arteries of the lower limbs are named differently as they pass into different body regions, even though there are no major branches. The external iliac artery, in the pelvis, becomes the femoral artery in the thigh, and it becomes the popliteal artery in the popliteal space, which is the posterior region of the knee.

The popliteal artery branches slightly inferior to the knee to give off the anterior tibial artery and the posterior tibial artery. The anterior and posterior tibial arteries give rise to arteries that supply blood to the feet. The anterior tibial artery becomes the dorsalis pedis artery at the ankle.

EXTERNAL CAROTID: Anterior: superior thyroid - superior laryngeal - lingual -sublingualfacial: angular - ascending palatine - submental - inferior labial - superior labialPosterior and ascending: occipital - posterior auricular - stylomastoid - ascending pharyngeal - meningeal branches of the ascending pharyngeal - posterior meningealTerminal: superficial temporal - transverse facial - middle temporal - zygomaticoörbitalinternal maxillary - 1st part: anterior tympanic - deep auricular - middle meningeal - superior tympanic - accessory meningeal - inferior alveolar - lingual2nd part: masseteric - buccinator - posterior superior alveolar3rd part: infraorbital - descending palatine - artery of the pterygoid canal - sphenopalatine | (Gray's s144)

Arteries of head and neck

INTERNAL CAROTID: cervical portion - petrous portion - cavernous portionophthalmic - orbital group: lacrimal - supra-orbital - posterior ethmoidal - anterior ethmoidal - medial palpebral - supratrochlear - dorsal nasalocular group: central retinal - ciliary)anterior cerebral - anterior communicating - middle cerebral - posterior communicating - anterior choroidal - circle of Willis | (Gray's s146 - Gray's s147

SUBCLAVIAN: vertebral: anterior spinal - posterior inferior cerebellar - basilar (internal auditory - anterior inferior cerebellar - superior cerebellar - posterior cerebral)thyrocervical trunk: inferior thyroid - inferior laryngeal - ascending cervical - suprascapular - transverse cervicalinternal thoracic: musculophrenic - anterior intercostal - pericardiacophrenic - superior epigastriccostocervical trunk: highest intercostal, deep cervical | (Gray's s148)

Arteries of upper limbs

•AXILLARY: superior thoracic - thoracoacromial - lateral thoracic - subscapular - scapular circumflex - dorsal scapular - posterior humeral circumflex - anterior humeral circumflex | (Gray's s149)

•BRACHIAL: superior ulnar collateral - inferior ulnar collateral | (Gray's s150)

•RADIAL: deep palmar arch - radial recurrent - superficial palmar arch - dorsal carpal - dorsal carpal network - dorsal metacarpal - princeps pollicis - radial of index finger - volar metacarpal | (Gray's s151)

•ULNAR: anterior ulnar recurrent - posterior ulnar recurrent - common interosseous - volar interosseous - posterior interosseous - interosseous recurrent - common volar digital | (Gray's s152)

Arteries of thorax and abdomen

pulmonary - aorta - ascending aorta - aortic sinus - coronary - right coronary - posterior descending - left coronary - Left circumflex - aortic arch - brachiocephalic - thyreoidea ima - common carotid | (Gray's s141-Gray's s143)

•THORACIC AORTA: bronchial - esophageal - intercostal - subcostal | (Gray's s153)

•ABDOMINAL AORTA: Visceral branches: celiac - left gastric - hepatic: right gastric - gastroduodenal - right gastro-omental - superior pancreaticoduodenal - cysticsplenic: pancreatic branches - arteria pancreatica magna - short gastric - left gastro-omentalsuperior mesenteric: inferior pancreaticoduodenal - intestinal - ileocolic - right colic - middle colic - inferior mesenteric: left colic - sigmoid - superior rectalmiddle suprarenal - renal - inferior suprarenal - internal spermatic - ovarianParietal branches: inferior phrenic - lumbar - median sacralTerminal branches: common iliac - marginal - internal iliac | (Gray's s154)

•INTERNAL ILIAC: umbilical - superior vesical - to ductus deferens - middle vesical - inferior vesical - middle rectal - uterine - azygos of the vagina - vaginal - obturatorinternal pudendal: inferior rectal - perineal - artery of the urethral bulb - urethral - deep artery of the penis - dorsal artery of the penisinferior gluteal: accompanying of ischiadic nerve - crucial anastomosisiliolumbar - lateral sacral - superior gluteal | (Gray's s155)

•EXTERNAL ILIAC: inferior epigastric - cremasteric - deep circumflex iliac | (Gray's s156)

Arteries of lower limbs

•FEMORAL: superficial epigastric - superficial iliac circumflex - superficial external pudendal - deep external pudendal - profunda femoris - lateral femoral circumflex - medial femoral circumflex - perforating - highest genicular | (Gray's s157)

•POPLITEAL: anterior tibial - sural - superior genicular - middle genicular - inferior genicular | (Gray's s159)

•ANTERIOR TIBIAL: dorsalis pedis - posterior tibial recurrent - peroneal - anterior tibial recurrent - anterior medial malleolar - anterior lateral malleolar | (Gray's s160)

•DORSALIS PEDIS: lateral tarsal - medial tarsal - arcuate - deep plantar | (Gray's s161)

•POSTERIOR TIBIAL: peroneal - medial plantar - lateral plantar - plantar arch - plantar metatarsal | (Gray's s162)

THE END