Month: February 2019

The system of the superior vena cava, the superior vena cava, is a thick (about 2.5 cm) but short (5–6 cm) trunk, located on the right and somewhat behind the ascending aorta.

The superior vena cava is formed from the confluence vv. brachiocephalicae dextra et sinistra behind the junction I of the right rib to the sternum. From here it goes down along the right edge of the sternum behind the first and second intercostal spaces and at the level of the upper edge of the third rib, hiding behind the right ear of the heart, flows into the right atrium.

Its back wall is in contact with a. pulmonalis dextra, which separates it from the right bronchus, and for a very short distance, at the site of the confluence with the atrium, with the upper right pulmonary vein; both of these vessels cross it transversely.

At the level of the upper edge of the right pulmonary artery, v. Flows into the superior vena cava. azygos, bending over the root of the right lung (the aorta bends over the root of the left lung). The anterior wall of the superior vena cava is separated from the anterior wall of the chest by a rather thick layer of the right lung.

On the sole of the foot are two plantar arteries – aa. plantares medialis et lateralis, which represent the terminal branches of the posterior tibial artery.

The thinner of the two a. plantaris medialis is located in sulcus plantaris medialis. At the head of the first metatarsal bone, it ends, connecting with the first plantar metatarsal artery or falling into the arcus plantaris; along the way gives branches to the adjacent muscles, joints and skin.

Larger a. plantaris lateralis goes to the sulcus plantaris lateralis, to the medial side of the base of the V metatarsal bone, where it turns steeply to the medial side and, forming an anastomosis with the ramus plantaris on the bases of the metatarsal bones with an anterior swell a. dorsalis pedis. In addition, it gives a sprig to connect with a. plantaris medialis. Thus, the arteries of the sole, experiencing constant pressure while standing and walking, form two arcs, which, unlike the arcs of the hand, are not located in parallel, but in two mutually perpendicular planes: in horizontal – between aa. plantares medialis et lateralis and in the vertical – between a. plantaris lateralis and a. plantaris profundus.

Branches of the lateral plantar artery:
a) branches to the adjacent muscles and skin;
b) aa. metatarseae plantares (four), which at the posterior end of each of the metatarsal gaps are connected to the prothropic posterior posterior arteries, at the anterior end – to the prothoric arteries and disintegrate into the plantar digital arteries, aa. digitales plantares, which from the second phalanx send branches to the back of the fingers. As a result, there are two rows of piercing arteries on the foot connecting the vessels of the rear and the soles. These piercing vessels, connecting aa. metatarseae plantares with aa. metatarseae dorsales, thereby forming anastomoses between a. tibialis anterior and a. tibialis posterior. Therefore, it can be said that these two main arteries of the tibia have on the foot in the tarsus area two types of anastomoses: 1) arcus plantaris and 2) rami perforantes.

The branches of the dorsal artery of the foot At the rear of the foot passes a. dorsalis pedis, the dorsal artery of the foot, which is a continuation of the anterior tibia artery, located on the bones in the ligaments and having medially from the tendon of the long extensor of the thumb, and lateral – medial abdomen of the short extensor of the fingers. Here on a. dorsalis pedis, you can determine the pulse by pressing it against the bones. In addition to 2 – 3 skin sprigs branching out in the skin of the rear and the medial side of the foot, the dorsal artery of the foot gives the following branches:

1. Ah. tarseae mediales, medial tarsi arteries, —to the medial edge of the foot.

2. A. tarsea lateralis, lateral tarsal artery; moves to the lateral side and at its end merges with the next branch of the artery of the foot, namely with the arcuate artery.

3. A. arcuata, arcuate artery, moves away against the medial sphenoid bone, is sent to the lateral side along the bases of the metatarsal bones and anastomoses with the lateral tarsal and plantar arteries; arcuate artery gives anteriorly three aa. metatarseae dorsales – the second, third and fourth, bound in the corresponding interosseous metatarsal intervals and dividing each into two aa. digitales dorsales to the sides of the fingers facing each other; each of the metatarsal arteries gives the piercing branches, anterior and posterior, extending to the sole. Often a. arcuata is weak and is replaced by a. metatarsea lateralis, which is important to consider when studying the pulse on the arteries of the foot with endarteritis.

4. A. metatarsea dorsalis prima, the first dorsal metatarsal artery, represents one of the two terminal branches of the dorsal artery of the foot, goes to the gap between the I and II fingers, where it is divided into two finger branches; even earlier division gives the branch to the medial side of the thumb.

5. Ramus plantaris profundus, the deep plantar branch, the second, larger of the terminal branches into which the dorsal artery divides, goes through the first interplusar spacing to the sole, where it participates in the formation of the plantar arch, arcus plantaris.

The branches of the posterior tibial artery A. tibialis posterior, the posterior tibial artery, is a continuation of the popliteal artery. Going down the canalis cruropopliteus, it is on the border of the middle third of the leg with the bottom coming out from under the medial edge m. solei and becomes more superficial. In the lower third of the leg a. tibialis posterior lies between m. flexor digitorum longus and m. flexor hallucis longus, medial to Achilles tendon, covered here only with skin and fascial sheets. Walking around the back of the medial ankle, it is divided on the sole into two of its final branches: aa. plantares medialis et lateralis. Pulse a. tibialis posterior is felt by pressing it against the medial ankle.

The largest branch of the posterior tibial artery a. peronea (fibularis), peroneal artery, moving away from a. tibialis posterior in the upper third of the last, is sent to canalis musculoperoneus inferior and ends at the heel bone.

A. tibialis posterior and a. peronea on its way give branches to nearby bones, muscles, joints (posterior ankle branches) and skin.

The branches of the anterior tibial artery. A. tibialis anterior, the anterior tibial artery, is one of two terminal branches of the popliteal artery (smaller in caliber). Immediately after the onset, it pierces the deep muscles of the flexor surface of the tibia and through the hole in the interosseous membrane goes into the anterior region of the tibia, passes between m. tibialis anterior and m. extensor digitorum longus, and below lies between m. tibialis anterior and m. extensor hallucis longus. Above the ankle joint, it passes superficially, covered with skin and fascia; its continuation on the back of the foot is called a. dorsalis pedis.

The branches of the anterior tibial artery, a. tibialis anterior:
1. A. recurrens tibialis posterior, posterior recurrent tibial artery (up to the opening), to the knee joint and to the joint between the fibula and painful tibial bones.
2. A. recurrens tibialis anterior, the anterior recurrent tibial artery (after the opening), goes to the lateral edge of the patella, participating in the formation of the rete articulare genus.
3. Ah. malleolares anteriores medialis et lateralis, anterior ankle arteries, lateral and medial, are involved in the formation of rete malleolare mediale et laterale.

The branches of the popliteal artery A. poplitea, the popliteal artery, is a direct continuation of the femoral artery. In the popliteal fossa a. poplitea is located on the bone itself (where it can be pressed against the bone in the half-bent position of the limb) and the posterior surface of the articular capsule anteriorly and somewhat medially from v. poplitea; further down the artery lies on the back surface m. popliteus covered heads m. gastrocnemius, and then, going under the edge of m. soleus, is divided into two final branches (aa. tibiales anterior et posterior).

1. Ah. genus superiores lateralis et medialis, the upper knee arteries, lateral and medial, extend at the level of the upper edge of the condyle of the condyle; each around the knee joint goes around to its front surface, where, joining the fistula between them, they participate in the formation of the arterial network of the knee joint (rete articulare genus).

2. Ah. genus inferiores lateralis et medialis, the lower knee arteries, lateral and medial, in the region of the knee joint branch like the upper arteries, but depart from a. poplitea at the level of the lower edge of the condyle of the femur.

3. A. genus media, the middle knee artery, extends in the middle between the upper and lower arteries of the knee joint, pierces the articular capsule and forks in the cruciate ligaments.

The branches of the femoral artery A. femoralis, the femoral artery, represents the continuation of the trunk of the external iliac artery, deriving its name from the site of passage under the inguinal ligament through the lacuna vasorum near the middle of the extension of this ligament. To stop bleeding, the femoral artery is pressed against the pub pub at the place of its exit to the thigh. Medially from the femoral artery lies the femoral vein, with which it passes in the femoral triangle, going first to sulcus iliopectineus, then to sulcus femoralis anterior, and then penetrates through the canalis adductorius into the popliteal fossa, where it continues to a. poplitea

The branches of the femoral artery, a. femoralis:

1. A. epigastrica superficialis, superficial epigastric artery, retires at the very beginning of the femoral artery and goes under the skin to the navel.

2. A. circumflexa ilium superficialis, the superficial artery enveloping the iliac bone, is directed to the skin in the spina iliaca anterior superior region.

3. Ah. pudendae externae, the external genital arteries, depart in the region of hiatus saphenus and are directed to the external genitals (usually two in number) – to the scrotum or to the labia majora.

4. A. profunda femoris, the deep artery of the femur, is the main vessel through which the vascularization of the femur. It is a thick trunk that departs from the back side of a. femoralis 4–5 cm below the inguinal ligament, lies first behind the femoral artery, then appears on the lateral side and, giving up numerous branches, rapidly decreases in its caliber.

a) a. circumflexa femoris medialis, going medially and upward, gives branches to m. pectineus, leading to the muscles of the thigh, and to the hip joint;
b) a. The circumflexa femoris lateralis departs somewhat lower than the previous one, is sent to the lateral side under m. rectus, where it is divided into ramus ascendens (goes up and laterally to the greater skewer) and ramus descendens (branches out in tons quadriceps);
c) aa. perforantes (three) move away from the posterior surface of the deep artery of the thigh and, piercing the adductors, pass to the posterior surface of the thigh; the first piercing artery gives the upper feeding thigh artery to the femur (a. diaphyseos femoris superior), and the third to the lower artery (a. diaphyseos femoris inferior); aa perforantes are of paramount importance when bandaging the femoral artery below the level of discharge of the deep femoral artery.

5. Rami musculares femoral artery – to the thigh muscles.

6. A. genus descendens, the descending artery of the knee, moves away from a. femoralis on its way to canalis adductorius and, going out through the front wall of this channel together with n. sap-henus, supplies m. vastus medialis; participates in the formation of the arterial network of the knee joint.

Parietal branches of the internal iliac artery. A. iliaca interna, starting from the lower end of the common iliac artery at the level of the sacroiliac joint, descends into the small pelvis and extends to the upper edge of the large sciatic hole. Its division into branches, near-wall and visceral, is subject to significant individual variations, but more often it is divided at the level of the upper edge of the large sciatic opening first into two main trunks – the rear, giving aa. iliolumbalis, sacralis lateralis, glutea superior, and the front, from which all other branches of a. iliacae internae. On the way a. iliaca interna is covered with the peritoneum, and the ureter runs down the front, which is important to take into account during the operation so as not to bandage it instead of the artery; v lies behind. iliaca interna.

A. iliaca communis, common iliac artery. The right and left arteries represent the two terminal branches, into which the aorta splits at the level of the IV lumbar vertebra slightly to the left of the midline, why the right common iliac artery is 6-7 mm longer than the left. From the place of aortic aa split. The iliacae communes diverge at an acute angle (in a man the angle of divergence is approximately 60 °, in a woman due to a greater width of the pelvis 68–70 °) and are directed down and laterally to the sacroiliac joint, at the level of which each is divided into two final branches: a. iliaca interna for the walls and organs of the pelvis and a. iliaca externa mainly for lower limbs.

By origin aa. iliacae communes are the initial segments of the umbilical arteries of the embryo; almost all the rest of the germinal aa. In adults, umbilicales are obliterated and turn into ligg. umbilicalia mediales.

1. A. suprarenalis media, the middle adrenal artery, starts from the aorta near the beginning of a. mesenterica superior and goes to gl. suprarenalis.

2. A. renalis, the renal artery, departs from the aorta at the level of the II lumbar vertebra almost at a right angle and goes in the transverse direction to the gate of the corresponding kidney. The caliber of the renal artery is almost equal to the superior mesenteric, which is explained by the urinary function of the kidney, which requires a large flow of blood. The renal artery sometimes departs from the aorta with two or three trunks and often enters the kidney with multiple trunks not only in the portal area, but throughout the medial edge, which is important to consider when pretreatment of the arteries during a kidney removal operation. At the gate of the kidney a. renalis is usually divided into three branches, which in turn in the renal sinus, in turn, fall into numerous branches (see. “Kidney”).

The right renal artery lies behind v. cava inferior, pancreatic head and pars descendens duodeni, left – behind pancreas. V. renalis is located in front and slightly below the artery. From a. renalis moving upward to the lower part of the adrenal gland a. suprarenalis inferior, as well as a sprig to the ureter.

3. A. testucularis (in women a. Ovarica) is a thin long stem, which starts from the aorta immediately below the beginning of a. renalis, sometimes from this last. Such a high discharge of the artery that feeds the testicle is determined by laying it in the lumbar region, where a. testicularis occurs at the shortest distance from the aorta. Later, when the testicle descends into the scrotum, a is also extended along with it. testicularis, which, at the time of birth, descends along the front surface of m. psoas major, gives a branch to the ureter, goes to the inner ring of the inguinal canal and, together with the ductus deferens, reaches the testicle, which is why it is called a. testicularis. In a woman, the corresponding artery, a. ovarica, in the inguinal canal is not sent, and goes into the small pelvis and then in the lig. suspensorium ovarii to the ovary.