Vascular structure of head and neck

Almas khanRadiographer

Khorfakkhan Hospital

Vascular structure of head and neck

Talk plan:-

Explain Vascular system and Circulations Co relation with Anatomical landmark Common Indications.

Components of circulatory system

Circulatory system

Cardiovascular Lymphatic system Cardio Vascular Lymph

(heart) (vessels) Lymph vessels Lymphatic nodules

Pulmonary Systemic ( lung) ( body)

The circulatory system consists of cardiovascular and lymphatic components .The cardiovascular portion includes heart, blood , and vessels that Transport the blood.

Blood vessels

• Arteries: carry blood away from the heartArterioles – smallest

arteries , carrying blood to tissue.

• Veins: carry blood back to the heart

• Venules – smallest vein , returning blood from tissue.

• Capillaries: microscopic blood vessels .

Blood vessels

• Carry blood to and from the heart

• Blood moving away from the heart: full of oxygen and nutrients

• Blood moving back to the heart: full of carbon dioxide and wastes

• blood only moves in one direction

3 sections of circulatory system

• Coronary circulation

• Pulmonary circulation

• Systemic circulation

Coronary Circulation• Flow of blood to and from tissues of the heart Coronary artery – blood supply to heart muscles.• The right coronary artery branches into: • Right marginal artery • Posterior descending artery

• The left main coronary artery branches into:• Circumflex artery • Left Anterior Descending artery

Venous drainage :-• Coronary sinus – venous drainage from heart

Pulmonary Circulation

• Flow of blood through the heart, to the lungs, and back to the heart

• Venous Blood returning to the heart enters the right atrium.– Enters through 2 major veins: superior and interior vena

cava• Superior vena cava: returns blood from head and neck• Inferior vena cava: returns blood from lower body

– Blood is high in carbon dioxide and low in oxygen

Systemic Circulation

• Oxygen-rich blood flows to organs and body tissues, and oxygen-poor blood returns to the heart

• Largest of the three parts of the circulatory system

• Oxygen-rich blood exits left ventricle, enters aorta, and is taken throughout body by arteries and capillaries

• Oxygen-poor blood is taken back to heart by veins, then superior and inferior vena cava take this blood to heart’s right atrium

Vascular structure

AortaFour segments of Aorta 1) Aortic bulb ( root )2) Ascending aorta3) Ascending arch 4) Descending aorta.

Branches of Arch of Aorta :-1) Brachiocephalic artery2 ) Left common carotid artery3) Left subclavian artery

Arch of aorta Variants of Arch :-A) Left circumflex – Arch to leftB) Inverse aorta – Arch to rightC) Pseudocoarctation - Arched descending aorta

Normal

Head and neck arteries

• Blood Supply of the Brain : - The four major arteries supplying the brain

• 1 ) Right common carotid artery• 2) Left common carotid artery• 3) Right vertebral artery• 4) Left vertebral artery

Head and neck arteries

• 1) The brachiocephalic trunk bifurcates in to • a) Right subclavien artery• b) Right common carotid

2) Right and Left vertebral artery arise from subclavien artery on each side

Bifurcation posterior to right sterno clavicular joint.

Head and neck arteries

Subclavian Artery

Right Subclavian Artery• Arises from the brachiocephalic artery,

behind the right sternoclavicular joint • Arches upward and laterally over the

pleura and between the scalens anterior and medium muscles.

• At the outer border of the first rib, it becomes the axillary artery.

Left Subclavian Artery• Arises from the arch of the aorta in the

thorax. • Ascends to the root of the neck and

then arches laterally in a manner similar to that of the right subclavian artery

Head and neck arteriesEach common carotid divides in to internal and external carotid arteries at the levels of C3 - C4 ( upper border of thyroid cartilage )

Left common carotid is slightly longer than the right, because it directly arise from the arch.External carotid artery branches :- a) facial arteryb) Maxillary arteryc) Superficial temporal artery d) Occipital artery supply – neck , face , scalp and meninges

Head and neck arteriesExternal carotid artery branches :-facial artery Maxillary artery Superficial temporal artery .Superior thyroid artery

Occipital artery supply – neck , face , scalp and meninges

Head and neck arteriesInternal carotid arteries :- ICA• Passes through carotid canal in the petrous

part of temporal bone.

• The ICA passes through a collection of venous channel around of sella turcica .

• ICA passes through dura matter medial to

each anterior clinod process to supply the cerebral hemispheres.

• The anterior circulation of brain supplied by ICA

• The S – Shaped portion of each internal carotid artery is termed the carotid siphon.

Head and neck arteries

• Vertebral artery : -• Right and Left vertebral artery

arise from subclavien artery on each side

• They pass through transverse foramina of vertebra C6 to C 1

• Then pass through foramen magnum posterior and enter in to cranium.

• The two vertebral arteries supplied posterior circulation of the brain.

Head and neck arteriesAnterior cerebral artery :- Each internal carotid branches in to anterior cerebral artery and middle cerebral artery.

Anterior cerebral artery supplies the forbrain on the midline and also mid portion of cerebral hemispheres .

Each anterior cerebral artery connects to the opposite one, and posterior circulation.

Anterior cerebral artery

Head and neck arteries

Middle cerebral artery :-Largest portion of the ICAIts supplies lateral aspects of anterior circulation and central lobe of brain.

Head and neck arteries

Vertebro basilar artery :-Both vertebral arteries enter the cranium through foramen magnum and unite to form basilar artery.

Its supplies spinal code and hindbrainBasilar artery rests on clivus Basilar artery gives several branches to hindbrain and posterior cerebrum

Head and neck arteriesCOW……. ?

Head and neck arteries

Circle of Willis :-Blood to brain supplied by ICA and VAPosterior circulation communicates with anterior circulation at the base of brain as the Circle of Willis.Five arteries form the COW.

1) Anterior communicating artery2) Anterior cerebral artery3) Internal carotid artery4) Posterior communicating artery.5) Posterior cerebral artery

Head and neck arteriesCircle of Willis

Common Indications Aneurysm :- The blood filled bulge of blood vessels , wall become waek.

Infracts :- An area of dead tissue caused by a loss of blood supply.

AVM :- AV malformation is an abnormal connection between the arteries and veins

Hemorrhage :-To lose blood rapidly and uncontrollably CVA :- It is interruption of the blood supply to the brain, usually because a

blood vessel bursts or is blocked . Stroke :- The loss of brain functions when blood supply suddenly

interrupted. Thrombosis :- It’s the formation of blood clot inside the blood vessels TIA :-(TIA) is a transient episode of neurologic dysfunction caused by ischemia Stenosis :- Narrowing of an artery inside the brain , Caused by buildup

plaque inside the artery.

AneurysmAn aneurysm is an abnormal, weak spot on a blood vessel that causes an outward bulging or ballooning of the arterial wall

A hemorrhagic stroke when they rupture, which can lead to brain damage and death.

How Aneurysm happen

Indications ACA Infract Left MCA and ACA infract

Indication of head and neck vessels MCA Infract

left MCA and PCA

AV Malformation

Hemorrhage TIA

Stenosis

Venous drainageDural sinus ( Sinuses of dura mater):-Venous channels which drain blood from brain.

It consist of 1) superior sagittal 2) inferior sagittal 3) straight sinus 4) Two transverse sinus 5) Occipital sinus

Confluence of sinus : Connecting point of superior sag , straight and occipital .

Venous drainageSup sag sinus : Received blood from cerebral cortex

Inferior sag sinus :- It received blood from mid cerebral hemispheres.Straight sinuses :- Received blood from inferior sag , vein of galan , sup cerebellar vein.Vein of Galan :- it receive blood from a collection of small vein.Transverse sinus :- from posterior aspect.Sigmoid sinus :- posteriorly and inferiorly

Head and neck vein

Great vein of the neck :- The three pairs of major veins that

drain the head , face and neck.

1) Right and Left Internal jugular vein

2) Right and left external jugular vein3) Right and left vertebral veins.

Head and neck vein• Each Internal jugular vein drain to

meninges and brain.

• Pair of external jugular veins are more superficial trunks that drain scalp face and neck

• Each external jugular vein join Subclavian vein

• Right and left vertebral vein outside of cranium and drain the upper neck and occipital region. Enters transverse foramin C1 – C6 joint to subclavien vein

Head and neck veinRight and left Branchiocephalic vein :- Join to from the superior vena cava , which returns blood to the right atrium

Venous trombosis

Bolus tracking time in MDCT :-

CTA Neck = 15 sec , F/R 3.5cc/sec

CTA Circle of Willis = 16 to 18 sec ,F/R 3.5sec

CT Brain routine = 5minuts after the injectionRoutine Neck = 20 to 30 sec , F/R 3.5 sec

CONCLUSION We are able to understand how the circulation of blood

is organized in the head and neck. Helps to identify vessels after injection of contrast. A good understanding of anatomy is essential while

performing angiography. Normal and abnormal distribution of circulatory system Co relation with Anatomical landmark helps to identify

vascular structures of head and neck precisely .

Thanks