Superior mesenteric artery

A. mesenterica superior, an artery, departs from the anterior surface of the aorta immediately below the cervical trunk, goes down and forward into the gap between the lower edge of the pancreas in front and the horizontal part of the duodenum at the back, enters the mesentery of the small intestine and descends to the right ileal fossa.

Branches, a. mesentericae superioris:

a) a. pancreatieoduodeiialis inferior goes right along the concave side of the duodeni towards aa. pancreaticoduodenales superiores;

b) aa. intestinales — 10–16 branches that extend from a. mesenterica superior in the left side to the lean (aa. jejundles) and ileum (aa. ilei) intestine; along the way, they are divided dichotomously and adjacent branches are connected to each other, which results in aa. jejunales are three rows of arcs, and along aa. ilei – two rows. Arcs are a functional device that provides blood flow to the intestines during any movements and positions of its loops. From the arcs there are many thin branches that circle the intestinal tube;

c) a. ileocolica runs from the a.r mesenterica superior to the right, supplying the lower part of the intestinum ileum and the cecum with sprigs and sending to the vermiform process a. appendicularis, passing behind the final segment of the ileum;

d) a. colica dextra goes behind the peritoneum to colon ascendens and near it is divided into two branches: ascending (going up towards a. colica media) and descending (going down towards a. ileocolica); branches form adjacent arcs of the colon;

e) a. colica media passes between the sheets of mesocolon transversum and, reaching the transverse colon, is divided into right and left branches, which diverge in the appropriate direction and anastomose: the right branch – with a. colica dextra, left – with a. colica sinistra

Unpaired visceral branches: celiac trunk (truncus coeliacus)

1. Truncus coeliacus, the celiac trunk, is short (2 cm), but a thick artery that moves at the level of the XII thoracic vertebra in the hiatus aorticus diaphragm, goes forward over the upper edge of the pancreas and immediately divides into three branches (the division point is called tripus coeliacus ): a. gastrica sinistra, a. hepatica communis and a. lienalis.

1. A. gastrica sinistra, the left gastric artery, goes to the lesser curvature of the stomach, gives branches to both the stomach and pars abdominalis esophagi.

2. A. hepatica communis, the common hepatic artery, goes along the upper edge of the pancreatic head to the superior edge of the duodeni, hence after the release of a. gastroduodenalis (which may be multiple) she is like a. hepatica propria (own hepatic artery) is sent to the gate of the liver, located between two sheets of lig. hepatoduodenal, and in a bundle it lies anterior to v. portae and to the left of ductus choledochus.

In the gates of the liver a. hepatica propria is divided into ramus dexter and ramus sinister; ramus dexter near the junction of ductus hepatic communis with ductus cysticus gives the artery of the gallbladder, a. cystica

From a. hepatica communis or a. hepatica propria leaves a branch to the lesser curvature of the stomach, a. gastrica dextra, going from right to left towards a. gastrica sinistra. Mentioned above a. gastroduodenalis passes behind duodenum and is divided into two branches: a. gastroepiploica dextra, which goes from right to left along the greater curvature of the stomach, gives branches to the stomach and to the omentum, in the front wall of which it passes, and aa. pancreaticoduodenals superiores, which branch out in the pancreas head and descending part of the duodeni.

3. A. lienalis, s. splenica, the splenic artery, the largest of the three terminal branches of the celiac trunk, travels along the upper edge of the pancreas to the spleen, approaching which, splits into 5-8 terminal branches entering the spleen gate.

On the way gives rami pancreatici. Near the division into terminal branches, the splenic artery gives a. gastroepiploica sinistra, which goes from left to right along the greater curvature of the stomach and joins a. gastroepiploica dextra, forms a (non-permanent) arterial arc, similar to the arc on the lesser curvature. From the arc depart numerous branches to the stomach.

In addition, after the discharge a. gastroepiploica sinistra from the splenic artery to the stomach go numerous aa. gastricae breves, which can fully compensate for the obstruction of blood flow in the main four arteries of the stomach. The latter form around the stomach arterial ring, or crown, consisting of two arcs, located along the small and large curvature. Therefore, they are also called coronary arteries.

Arcs and arteries of the hand. Superficial palmar arch.

Deep palmar arch. In the area of ​​the wrist there are two networks: one palmar, rete carpi palmare, the other rear, rete carpi dorsale.

Rete carpi palmare is formed from the junction of the palmar carpal branches of the radial and ulnar arteries and branches from the anterior interosseous. The palm network of the wrist is located on the ligamentous apparatus of the wrist under the flexor tendons; its branches feed the ligaments and articulationes mediocarpea et radiocarpea.

Rete carpi dorsale is formed from the junction of the posterior carpal branches of the radial and ulnar arteries and branches from the interosseous; located under the extensor tendons and gives branches:
a) to the nearest joints {yy. ag-ticuldres)
b) in the second, third and fourth inter-bone gaps {aa. te-tacarpeae dor sales); at the base of the fingers, each of them is divided into branches to the fingers {aa. digitales dorsdles).

On the palm there are two arcs – superficial and deep.

Arcus palmaris superficialis, superficial palmar arch, located under aponeurosis palmaris. Being a continuation of the ulnar artery, the surface arc decreases in its caliber towards the radial side, where it includes the superficial palmar artery branch. From the convex steel side of the arc are four aa. digitales palmares communes. Three of them go to the second, third and fourth interbone spacing, respectively, the fourth – to the ulnar side of the little finger. At the fold of skin between the fingers, each of them is divided into two aa. digitales palmares propriae, which are directed along opposite sides of adjacent fingers.

Arcus palmaris profundus, a deep palmar arch, is located deep beneath the flexor tendons on the bases of the metacarpal bones and ligaments, proximal to the superficial arc. The deep palmar arch, being formed mainly by the radial artery, decreases in its caliber in contrast to the surface towards the ulnar side of the hand, where it joins the relatively thin deep palmar branch of the ulnar artery. From the convex side of the deep arc, in the distal direction to the three inter-bone gaps, starting from the second, three aa. metacarpeae palmares, which in the interdigital folds merge with the ends of the common palmar finger arteries. Three small branches (aa. Perfordntes), which, going to the rear, anastomose with aa, depart from the arc in the dorsal direction through the interosseous gaps (second, third and fourth). metacarpeae dorsales.

The superficial and deep arterial arcs are an important functional device: in connection with the grasping function of the hand, the vessels of the hand are often compressed. When the blood flow in the superficial palmar arch is disturbed, the blood supply to the hand does not suffer, since blood delivery occurs in such cases through the arteries of the deep arc. The same functional devices are the articular networks, due to which blood flows freely into the joint, despite the compression and tension of the vessels during its movements. In the area of ​​the upper limb there are rich opportunities for the development of collateral circulation. Collateral vessel for a. brachialis is a. profunda brachii, for a. ulnaris – a. interossea communis.

Ulnar artery, a. ulnaris. Branches of the ulnar artery

Ulnar artery, a. ulnaris, represents one of the two terminal branches of the (larger) brachial artery. From the place of onset in the cubital fossa (against the neck of the radial bone), it fits under m. pronator teres, up to the middle third of the forearm goes sideways, deviating to the elbow side. In the lower two-thirds, it runs parallel to the ulna, first between the m. flexor digitorum superficialis and so on. flexor carpi ulnaris, in the lower third, due to the transition of muscles into tendons, its position becomes more superficial (sulcus ulnaris). At the radial side of the pea-shaped bone, the ulnar artery passes into canalis carpi ulnaris (spatium interaponeuroticum) and, passing on the palm, is part of the arcus palmaris superficialis.

Branches of the ulnar artery:
1. A. recurrens ulnaris, recurrent ulnar artery, gives two branches – rami anterior et posterior, which run in front of and behind the medial epicondyle, anastomosing with aa. collaterals ulnares superior et inferior. Thanks to these anastomoses, as well as the above anastomoses between the branches a. profunda brachii and a. radialis in the circumference of the elbow joint is obtained arterial network – rete articulare cubiti.
2. A. interossea communis, the common interosseous artery, goes to the interosseous membrane, at the proximal margin of which is divided into two branches:
a) a. interossea anterior to the anterior surface of the interosseous membrane reaches m. pronator quadratus, pierces the membrane and goes to the rear, where it ends in the rete carpi dorsale. At the beginning of your journey a. interossea anterior gives a. mediana (goes to the palm along with medianus), aa. diaphyseos radii et ulnae – to the bones of the forearm and rami musculares – to the surrounding muscles;
b) a. interossea posterior prohrdit through the upper opening of the interosseous membrane on the back side, gives a. interossea recurrens, lies between the superficial and deep extensor layers and anastomose in the wrist area with a. interossea anterior.
3. Ramus carpeus palmaris, the palmar carpal branch, goes towards the same-named branch of the radial artery, with which it anastomoses.

Radial artery, a. radialis Branches of the radial artery

Radial artery, a. radialis, the direction is a continuation of the brachial artery. It goes medially from m. brachioradialis, first covered by it, and later in sulcus radialis; in the lower third of the forearm, where the muscles pass into the tendons, the radial artery is covered from the surface only with the fascia and skin, which is why it serves because of easy accessibility for the study of the pulse. Reaching the top of the styloid process of the radius, a. The radialis passes to the rear, bending around the lateral edge of the wrist and lying down in the so-called snuff box, from where it goes to the palm in the first interosseous gap between the bases I and II of the metacarpal bones. In the palm, the radial artery along with the deep branch a. ulnaris forms the arcus palmaris profundus – a deep palmar arch.

The branches of the radial artery:
1. A. recurrens radialis, the return radial artery, begins in the ulnar fossa, goes in the proximal direction to the front surface of the lateral epicondyle, where it anastomoses with the above a. collateralis radialis of a. produnda brachii.
2. Rami musculares – to the surrounding muscles.
3. Ramus carpeus palmaris, the palm of the carpal branch, begins at the bottom of the forearm and goes to the elbow towards a similar branch from a. ulnaris. From anastomosis with ramus carpeus palmaris a. ulnaris on the palmar surface of the wrist is formed of rete carpi palmare.
4. Ramus palmaris superficialis, the superficial palmar branch, passes over the thenar or pierces its surface layers and, connected to the end of the ulnar artery, enters the arcus palmaris superficialis
5. Ramus carpeus dorsalis, the back carpal branch, moves away in the “snuffbox” area and with the eponymous branch a. ulnaris forms a network on the rear of the wrist, a rete carpi dorsale, which also receives branches from the interosseous arteries (aa. interosseae anterior et posterior).
6. A. metacarpea dorsalis prima, the first dorsal metacarpal artery, goes on the back of the hand to the radial side of the index finger and to both sides of the thumb.
7. A. princeps pollicis, the first artery of the thumb, moves away from the radial one as soon as the last penetrates the first interosseous gap into the palm, goes along the palm of the I metacarpal and divides into branches, aa. digitalis palmares, to both sides of the thumb and to the ray side of the index finger.

Brachial artery. Branches of the brachial artery: deep artery of the shoulder, upper and lower ulnar artery.

Brachial artery, a. brachialis, is a direct continuation of the axillary artery. Starting at the bottom edge m. teres major, it stretches into sulcus bicipitalis up to the elbow bend, where at the level of the neck the radial bone is divided into its final branches – the radial and ulnar arteries. On its way to sulcus bicipitalis medialis, it is accompanied by two brachial veins and nerves (n. Medianus, n. Ulnaris, n. Cutaneus brachii medialis et n. Cutaneus antebrachii medialis). In addition to small branches to the bone and muscles, the brachial artery gives the following branches:

1. A. profunda brachii, deep artery of the shoulder, moving away from a. brachialis shortly after the start of the latter; It is a large branch that, together with n. radialis, passes into canalis humeromuscu-laris, gives in its path an artery that feeds the humerus {a. diaphyseos humeri), and splits into a. collateralis media penetrating the thickness m. triceps and anastomosing with a. interossea recurrens (from a. interossea posterior), and a. collateralis radialis; the latter comes to the surface through the lower opening of the spiral canal, goes anterior to the epicondylus lateralis and anastomoses with a. recurrens radialis (branch a. radialis). The deep brachial artery often (50%) departs along with other branches of the brachial or axillary arteries or (30%) is absent.

2. A. collateralis ulnaris superior, superior ulnar collateral artery, extends from the brachial artery in the middle of the shoulder, descends into the sulcus behind the epicondylus medialis, where it anastomoses with a. recurrens ulnaris posterior (branch a. ulnaris).

3. A. collateralis ulnaris inferior, the lower ulnar collateral artery, extends from the brachial artery about 5 cm above the end of the latter and anastomizes anteriorly from the epicondylus medialis with a. recurrens ulnaris anterior (branch a. ulnaris).

Axillary artery, a. axillaris The branches of the axillary artery.

The axillary artery is a direct continuation of the subclavian artery, a. axillaris, which in turn continues into the brachial artery. The proximal border of the axillary artery trunk is the outer edge of the I rib, the distal border is the lower edge m. teres major (the origin of the brachial artery). The axillary artery lies in cavitas axillaris medially from the shoulder joint and the humerus; front and medial it is located v. axillaris and on three sides – the nerve trunks of the brachial plexus; From below, this neurovascular bundle is covered with skin, fascia, and accumulation of fatty tissue that contains lymph nodes.

In the course of a. axillaris distinguish three divisions:
1) from the clavicle to the upper edge, m. pectoralis minor (trigonum clavipectorale);
2) behind this muscle (trigonum pectorale);
3) from the bottom edge m. pectoralis minor to the bottom edge m. pectoralis major (trigonum subpectorale).

Branches a. axillaris in clagonpectorale trigonum:
1. A. thoracica superior, superior thoracic artery, forks into m. subclavius, both pectoral muscles, m. serratus anterior to the nearest intercostal muscles.
2. A. thoracoacromialis, hematoacromial, takes part in the nutrition of the shoulder joint, m. deltoideus and both pectoral muscles. In trigonum pectorale:
3. A. thoracica lateralis, the lateral pectoral artery, descends along the side wall of the rib cage and sends branches to the mammary gland and surrounding mshtsam.

In trigonum subpectorale:
4. A. subscapulars, the subscapularis artery, the largest branch of the axillary artery, begins near the lower margin m. subscapularis and goes down along this muscle, giving it branches; soon divided into two trunks:
a) a. The circumflexa scapulae leaves through the foramen trilaterum to the dorsal surface of the scapula, where it anastomoses with a. suprascapularis;
b) a. thoracodorsalis serves as a continuation of the subscapularis artery along the lateral edge of the scapula.
5. A. circumflexa humeri posterior, the posterior artery, which goes around the humerus, goes back to the foramen quadrilaterum, bypassing the surgical neck of the humerus behind; covered with deltoid muscle, which she gives branches.
6. A. circumflexa humeri anterior, the anterior artery that goes around the humerus, begins at the same level as the previous one, goes in the lateral direction, bends around the surgical neck of the shoulder from the front, anastomizing with the posterior surrounding artery, and gives branches to the muscles and shoulder joint .

All the branches of the axillary artery are widely anastomized with the branches of the subclavian artery; therefore, the ligation of the axillary artery is higher than a discharge from it a. subscapularis is more profitable than applying a ligature below. Also, ligation of the subclavian artery in its initial part often leads to gangrene, while ligation distal to the discharge of the truncus thyrocervicalis does not give such complications.

Subclavian artery, a. subclavia. The branches of the first division of the subclavian artery.

Left subclavian artery only, a. subclavia, refers to the number of branches extending from the aortic arch directly, while the right branch is the branch of truncus brachiocephalicus.

The artery forms a convex upward arc, enveloping the dome of the pleura. She leaves the chest cavity through apertura superior, approaches the collarbone, lies down in sulcus a. subclaviae I ribs and bends over it. Here, the subclavian artery can be pressed to stop bleeding to the I rib behind tuberculum m. scaleni. Then the artery continues into the axillary fossa, where, starting from the outer edge of the I rib, it is called a. axillaris On its way, the subclavian artery goes along with the brachial nerve plexus through the spatium interscalenum, so there are 3 sections: the first is from the beginning to the entrance to the spatium interscalenum, the second is in the spatium interscalenum and the third is at the exit from it, before going to a . axillaris

The branches of the first division of the subclavian artery (before entering the spatium interscalenum):
1. A. vertebralis, vertebral artery, the first branch extending upward between m. scalenus anterior and m. longus colli, is sent to the foramen processus transversus VI of the cervical vertebra and rises up through the holes in the transverse processes of the cervical vertebrae to the membrana atlantooccipitalis posterior, which, through the foramen magnum of the occipital bone, enters the cranial cavity. In the cranial cavity, the vertebral arteries of the one and the other sides converge to the midline and merge into one unpaired basilar artery near the posterior edge of the bridge, a. basilaris. On its way, it gives small branches to the muscles, spinal cord and hard shell of the occipital lobes of the brain, as well as large branches:
a) a. spinalis anterior departs in the cavity of the skull near the confluence of two vertebral arteries and goes down and to the midline towards the artery of the same side of the opposite side, from which it merges into one trunk;
b) a. The spinalis posterior departs from the vertebral artery immediately after it enters the cranial cavity and is also directed down the sides of the spinal cord. As a result, three arterial trunks descend along the spinal cord: unpaired – on the front surface (a. Spinalis anterior) and two paired – on the posterolateral surface, one on each side (aa. Spinales posteriores). All the way to the lower end of the spinal cord, they receive reinforcements in the form of rr through the intervertebral holes. spinales: in the neck – from aa. vertebrales, in the thoracic – from aa. intercostales posteriores, in lumbar – from aa. lumbales. Through these branches, the anastomoses of the vertebral artery are established with the subclavian artery and the descending aorta;
c) a. Cerebelli inferior posterior is the largest of the branches a. vertebralis, starts near the bridge, goes back and, bypassing the medulla oblongata, forks on the lower surface of the cerebellum.

A. basilaris, the basilar artery, is obtained from the fusion of both vertebrates, unpaired, lies in the median sulcus of the bridge, at the front edge of it is divided into two aa. cerebri posteriores (one on each side), which are directed back and up, bend around the lateral surface of the legs of the brain and branch out on the lower, inner and outer surfaces of the occipital lobe. Taking into account the above aa. communicantes posteriores from a. carotis interna, posterior cerebral arteries are involved in the formation of the arterial circle of the brain, circulus arteriosus cerebri. From the trunk a. The basilaris branch off small branches to the bridge, into the inner ear, passing through meatus acusticus internus, and two branches to the cerebellum: a. cerebelli inferior anterior and a. cerebelli superior.

A. vertebralis, which runs parallel to the trunk of the common carotid artery and participates along with it in the blood supply to the brain, is a collateral vessel for the head and neck. Merged into one trunk, a. basilaris, two vertebral arteries and two aa fused into one trunk. spinales anteriores, form the arterial ring, which, along with the circulus arteriosus cerebri – the Willisian arterial circle, is important for the collateral circulation of the medulla.

2. Truncus thyrocervicalis, the thymus, moves away from a. subclavia up at the medial edge m. The scalenus anterior, has a length of about 4 cm and is divided into the following branches: a)
a. thyroidea inferior goes to the posterior surface of the thyroid gland, renders a. laryngea inferior, which branches in the muscles and mucous membrane of the larynx and anastomoses with a. laryngea superior; branches to the trachea, esophagus and thyroid gland; the latter anastomose with branches a. thyroidea superior from system a. carotis externa;
b) a. cervicalis ascendens rises above m. scalenus anterior and supplies deep neck muscles;
c) a. The suprascapularis goes from the trunk downwards and laterally to the incusura scapulae, and bending over lig. transversum scapulae, branched in the dorsal muscles of the scapula; anastomoses with a. circumflexa scapulae.

3. A. thoracica interna, internal artery moving away from a. subclavia versus beginning a. vertebralis, goes down and medially, adjacent to the pleura; starting from the I rib cartilage, goes vertically downwards at a distance of about 12 mm from the edge of the sternum. Reaching the bottom edge of VII rib cartilage, a. thoracica interna is divided into two final branches: a. musculophrenica stretches laterally along the line of attachment of the diaphragm, giving to it both the nearest intercostal spaces of the branch and a. epigastrica superior – continues the way a. down thoracica interna, penetrates the vagina of the rectus abdominis muscle and, reaching the level of the navel, anastomose with a. epigastica inferior (from a. iliaca externa).

On the way a. thoracica interna gives branches to the nearest anatomical structures: connective tissue of the anterior mediastinum, thymus gland, lower end of the trachea and bronchi, to the six upper intercostal spaces and the mammary gland. Its long branch, a. pericardiacophrenica, together with n. phrenicus goes to the diaphragm, giving branches along the path to the pleura and pericardium. Her rami intercostales anteriores run in the upper six intercostal spaces and anastomose with aa. intercostales posteriores (from the aorta).