Rewording 3 Papers

Cerebrovascular

Aortic Arch:

● Commences at the Upper part of the left ventricle.

● Consists of the ascending aorta, transverse arch and descending aorta.

● Has three main branches which are the innominate artery, left common carotid

artery and left subclavian.

● The innominate artery divides into the right common carotid artery and the right

subclavian.

● The left common carotid artery second branch on the left side of the aortic arch

terminates at the carotid bifurcation.

● Left subclavian artery third branch on the left side of an aortic arch and

terminates at the thoracic outlet.

Upper extremity arteries:

Subclavian Artery:

● Located posterior to the clavicle and courses between the anterior and middle

scalene muscle and first rib.

● Right subclavian artery originates from the innominate artery.

● Left subclavian artery originates off the aortic arch; an important branch of the

subclavian artery is the internal mammary artery which is used in coronary artery

bypass surgery.

Axillary Artery:

● Continuation of the subclavian artery at the lateral border of the first rib.

Brachial Artery:

● At the level of the head of the humerus, the axillary artery becomes the brachial

artery and extends to the bend of the elbow.

● Initially lies medial to the humerus and gradually courses anteriorly to the

antecubital fossa where it bifurcates into the radial and ulnar arteries.

Radial Artery:

● Continuation of brachial artery.

● Passes along the lateral side of the forearm (radius ) to the wrist.

● It continues to the palm to form a deep palmar arch.

Ulnar Artery:

● Largest of the two terminal branches of the brachial artery.

● Passes along the medial side of the forearm (Ulnar) to the wrist

● Continues to the palm to form the superficial palmar arch.

Palmar Arch (Volar):

● Deep palmar arch: after the radial artery gives off a branch to the ulnar artery; it

terminates as the deep palmar arch.

● Superficial palmar arch; after the ulnar artery gives off a branch to the radial, it

terminates as superficial palmar arch.

● Deep palmar arch is located more proximal, closer to the wrist ; superficial

palmar arch is located more distal, closer to the digits.

● Digital arteries of hand arise off the palmar arches to feed the fingers.

Cervical Carotid

Common Carotid Artery:

● Located lateral to the trachea and thyroid gland; bifurcates into internal carotid

and external carotid arteries at the superior aspect of the thyroid.

● Right common carotid artery usually originates from the innominate artery;

although rarely.

● It may arise directly off the aortic arch or in conjunction with the left common

carotid artery.

● LCCA is longer than RCCA and usually originates directly off the aortic arch.

● Origin of the LCCA varies; it's been seen to originates from the innominate or on

occasion both common carotid arteries may originate from a single trunk when

there is no innominate artery.

External carotid Artery:

● Commences at the upper border of the thyroid cartilage where the CCA

bifurcates.

● ECA gives off eight branches which supply blood to high resistance vascular

beds; face. scalp, and neck.

● ECA branches into superior thyroid artery, ascending pharyngeal, lingual,

occipital, facial, posterior auricle, maxillary and superficial temporal.

Internal Carotid Artery:

● Commences at the upper border of the thyroid cartilage where the CCA

bifurcates.

● Supplies blood to low resistance vascular beds: the anterior portion of the brain

and the eyes with branches to the foreheads and nose.

● Typically it doesn't have cervical branches.

● Once inside the skull, the first major branch is the ophthalmic artery at the level

of the carotid siphon.

● Ophthalmic artery enters the orbit through the optic foramen and divides into its

terminal branches; frontal, nasal, and supraorbital.

Vertebral Arteries:

● Arise from the upper and back of the proximal subclavian artery and enter the

skull through the foramen magnum.

● First and largest branch of the subclavian artery.

● Provide blood supply to the posterior part of the brain

● Left vertebral artery is usually larger than right.

● Both vertebrals unite in the midline to form the basilar artery, also known as

vertebrobasilar circulation.

● Branches of the vertebral arteries supply the medulla and the interior surface of

the cerebellum.

Intracranial Circulation (Circle of Willis)

Basilar:

● Located at the base of the skull an is formed by the two vertebral arteries.

● Terminates by dividing into two posterior cerebral arteries.

● Provides blood supply to the entire pons and superior and anterior aspects of the

cerebellum.

Circle of Willis:

● Has three trunks that together supply each cerebral hemisphere anterior,

anterolateral and posterior.

● Anterior : two anterior cerebral arteries that are branches of ICA connected by

the anterior communicating artery.

● Anterolateral: middle cerebral arteries.

● Posterior: formed by two posterior cerebral arteries which are branches of the

basilar artery connected by the posterior communicating arteries to the middle

cerebral arteries.

● Most important of collateral circulation in the cerebrovascular system.

● There are approximately nine congenital malformations of the circle of willis, the

most common is absence or hypoplasia of one or both communicating arteries.

Collateral Possibilities:

● Larger inter-atrial connections include the circle of willis, which is the major

collateral pathways; provide communication between the intracranial ICA, and

posterior cerebral circulation.

● Intracranial - extracranial includes an anastomosis between the ECA and the ICA

via the orbital and ophthalmic and other ECA/ICA connections.

Abdominal Aorta

● Abdominal aorta is located to the left of midline

● Courses from the diaphragm to L4 where it bifurcates into the common iliac

arteries.

● Normal size is 2cm- 3cm , tapering at the bifurcation to approximately 1.5cm.

● Considered to be enlarged when it measures more than 3.0cm-4.0cm.

● Main visceral branches of the abdominal aorta include Celiac Axis, Superior

Mesenteric Artery, Renal Arteries and Inferior Mesenteric Artery.

Lower Extremity Arteries

Aortic Bifurcation occurs at the level of the fourth lumbar vertebral, creating the common

iliac arteries .Right common iliac is longer than the left and crosses over the left iliac

vein.They branch into the internal and external iliac arteries at the lumbosacral junction.

Internal Iliac Arteries( Hypogastric Arteries) :

● Bifurcates into anterior and posterior arteries,

● Supply blood to the walls and viscera of the pelvis, genitals, penis and buttock.

● Have multiple branches that provide important collateral pathways in the

presence of external iliac obstruction.

External Iliac Arteries:

● Originates at the bifurcation of the common iliac arteries .

● Courses along the inner border of the psoas muscle from the bifurcation of the

common iliac to the inguinal ligament where they become the common femoral

arteries.

● They have two branches dorsally, the inferior epigastric which branches to the

external iliac artery and the deep iliac circumflex artery.

Common Femoral Artery:

● Lateral and anterior in common femoral vein.

● Formed from the external iliac artery beneath the inguinal ligament, coursing

lateral to the common femoral vein.

Deep Femoral ( profunda femoris) Artery:

● Originates art the bifurcation of the common femoral artery.

● Courses posterolateral at its origin and continuous medial to the femur where it

terminates in the distal third of the thigh as the perforating artery.

● Supplies blood to the thigh muscles and hip joint deep femoral artery.

● Its muscular branches are a critical collateral source in superficial femoral artery

obstruction.

Superficial Femoral Artery:

● Originates 4xm below the inguinal ligament, arising from the common femoral

artery.

● Courses along the mid aspect of the thigh. At the level of the adductor hiatus, in

the tendon of Hunter’s camel, it gives rise to the supreme genicular artery and

then continues as the popliteal artery.

Popliteal Artery:

● Begins at the adductor hiatus inferior to where the SFA gives rise to the genicular

branch.

● Descends lateral and ends at the popliteus muscle, diving into the anterior tibial

artery and tibioperoneal trunk.

● Has multiple genicular branches that supply blood to the knee region.

● Major branches include the gastrocnemius arteries which supply to

gastrocnemius muscles in the calf.

Anterior Tibial Artery:

● First branch off the distal popliteal artery.

● Courses between the tibia and fibula terminating at the dorsalis pedis artery on

the anterior surface of the foot.

● Feeds the anterior lateral aspect of the leg and parts of the foot.

Tibioperoneal Trunk:

● Second branch off the distal popliteal artery, behind medial malleolus.

● Terminates into medial ,lateral, and plantar arteries of the foot.

● Feeds the medial aspect of the lower leg and foot.

Peroneal Artery:

● Lies adjacent to the border of the fibula.

● Terminates as the external caldanel artery.

● Supplies the lateral aspect of the leg and foot.

Plantar Arteries:

● Posterior tibial artery divides into the small medial plantar and joins with the

branches of the dorsal pedal artery to form the plantar arch.

● Gives rises to the dorsal metatarsal branches to the digits.